Observations on recurrent syncope and presyncope in 641 patients.

Area of Science:

• Neurology
• Cardiology
• Autonomic Dysfunction

Background:

• Syncope is a common, potentially disabling condition affecting all ages.
• Diagnosis can be challenging after excluding neurological, cardiological, and metabolic causes.
• Autonomic dysfunction is a potential underlying cause in unexplained syncope.

Purpose of the Study:

• To determine if autonomic investigation aids diagnosis in patients with recurrent syncope and presyncope.
• To identify the diagnostic yield of autonomic testing in a tertiary referral center.

Main Methods:

• Retrospective analysis of 641 patients with recurrent syncope/presyncope referred between 1992-1998.
• Exclusion of patients with known autonomic failure; assessment of screening and additional autonomic tests.
• Evaluation of non-autonomic neurological, psychiatric, and other potential causes.

Main Results:

• Autonomic investigation confirmed chronic autonomic failure in 4.8% and diagnosed neurally mediated syncope in 43.5% (vasovagal syncope 35%).
• Other identified causes included cardiovascular (8.3%), non-autonomic neurological (6.7%), and psychiatric (8.7%).
• Syncope remained of unknown cause in 27.9% of patients.

Conclusions:

• Autonomic investigation is valuable in managing recurrent syncope when common causes are excluded.
• It helps in making, confirming, or excluding various diagnostic factors and specific conditions.
• This approach can significantly improve the diagnostic clarity and subsequent management of patients.