[Syncope in hospital internal medicine]

Syncope and presyncope are a relatively common problem in the general population. The differential diagnosis is complex, including benign forms and potentially life-threatening syndromes. In etiological terms, a variety of causes can be diagnosed, predominantly adopting a specialist approach to the problem. The aim of this study was to assess the epidemiological and clinical impact of syncope and presyncope in an internal medicine unit.

A prospective study was performed in cases of syncope and presyncope attending an internal medicine unit. A coded diagnostic and therapeutic protocol was used. The study included the cases discharged over a 6-month period (1/5/1998-31/10/1998).

Syncope and presyncope were present in 6.73% of cases, mainly in elderly persons, female sex and with cardiovascular forms (6.25%). Neurally mediated syndrome was the most common form, followed by cardiac and cerebrovascular diseases, in accordance with most reports. This study confirmed the diagnostic value of an accurate anamnesis and in-depth objective examination, integrated by basic ECG. It is important to underline that this global approach to the problem allowed the recognition of gastrointestinal hemorrhage and pulmonary embolism with the trait of monosymptomatic syncope and presyncope. In the absence of significant electrocardiographic data, more extensive testing in patients restricted the cases of unknown form to 7.14%.

Syncope and presyncope represent a multidisciplinary problem, frequently found in internal medicine, which benefits from the potential advantages of a global approach.