Syncope is a symptom that can be due to several causes, ranging from benign to life-threatening conditions. It can be benign or a symptom of an underlying medical condition. It most often occurs when blood pressure is too low (hypotension) and the heart doesn't pump enough oxygen to the brain. It's also called fainting or "passing out." Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. National Hypertension Control Initiative.Pets and Your Health / Healthy Bond for Life.4 History of dyspnea, chest pain, or palpitations argue for a primary cardiac or pulmonary cause. Key factors include the account of third-party observers, although it is important to note that tonic-clonic movements can be associated with the global cerebral hypoperfusion of syncope as well as with seizure. History: A detailed history and physical examination reveals the cause in 50% of syncopal episodes. Clinical Efficacy Assessment Project of the American College of Physicians. Part 1: Value of history, physical examination, and electrocardiography. Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN.AHA/ACCF Scientific Statement on the evaluation of syncope: from the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group and the American College of Cardiology Foundation: in collaboration with the Heart Rhythm Society: endorsed by the American Autonomic Society. Strickberger SA, Benson DW, Biaggioni I, et al.Patients can be reassured that, in the absence of underlying cardiac disease, syncope itself is not associated with increased mortality.Even inpatient telemetry, a routine part of standard evaluation, is helpful only 5% of the time. Cardiac enzymes, electroencephalography, CT scan of the head, and carotid ultrasonography contribute to diagnosis in less than 1% of cases.Initial evaluation of syncope should include medical history, physical examination, ECG, and postural blood-pressure testing.Among diagnostic tests, orthostatic blood pressure measurement (performed in about one-third of cases) is both the highest-yield test and the least expensive.An estimated 86% of individuals seen in the ED after a syncopal episode are admitted to the hospital.3 True syncope can be associated with other concerning causes, such as aortic stenosis, aortic dissection, and massive pulmonary embolus, as well as arrhythmias from underlying cardiac disease. 2 The primary objective for evaluation is identification of individuals at increased risk of death due to associated conditions, especially cardiac conditions such as structural heart disease myocardial ischemia and infarction (MI) Wolff-Parkinson-White, Brugada, or long QT syndromes and polymorphic ventricular tachycardia. Syncope is a common problem, accounting for 1% to 2% of ED visits in the U.S.
Nonsyncopal mechanisms, such as seizure and hypoglycemia, should also be considered in the differential diagnosis of transient loss of consciousness (see Table 1, p. The differential diagnosis of syncopal loss of consciousness includes neurally mediated (e.g., vasovagal) syncope, orthostatic hypotension, cardiac arrhythmias, structural heart disease, and cerebrovascular disease.Īmong young, otherwise healthy people, neurally mediated syncope, which has a relatively benign prognosis, is by far the most common etiology, while in older patients, primary cardiac causes are more common. The final common pathway of all causes of syncope is global cerebral hypoperfusion-specifically, hypoperfusion of the reticular activating system. Syncope is defined as sudden, self-terminating loss of consciousness.
What is the most cost-effective evaluation for this patient admitted with suspected first syncopal episode?
The primary E&M objective is identifying patients at increased risk of death due to associated conditions (e.g., heart disease, myocardial ischemia). Syncope accounts for 1% to 2% of ED visits in the U.S.
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