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Diagnostic value of history in patients with syncope with or without heart disease
P Alboni1, M Brignole, C Menozzi
1Division of Cardiology, Ospedale Civile, Cento, Italy. p.alboni@ausl.fe.it
Insights
Identifying the cause of syncope is crucial. Historical findings, particularly heart disease, effectively predict cardiac syncope, while other symptoms help distinguish neurally mediated causes.
Area of Science:
- Cardiology
- Neurology
- Internal Medicine
Background:
- Systematic investigation of syncope causes is lacking.
- Clinical features differentiating syncope types require clarification.
Purpose of the Study:
- To identify historical findings that predict the cause of syncope.
- To differentiate between cardiac and neurally mediated syncope based on patient history.
Main Methods:
- Prospective evaluation of 341 syncope patients.
- Standardized questionnaire for patient interviews.
- Assignment of syncope cause using defined diagnostic criteria.
Main Results:
- Cardiac syncope occurred in 23%, neurally mediated in 58%.
- Heart disease strongly predicted cardiac syncope (OR 16). Absence of heart disease excluded cardiac causes in 97%.
- Supine/effort syncope, blurred vision, and convulsive syncope predicted cardiac causes in heart disease patients. Abdominal discomfort, nausea, and diaphoresis predicted neurally mediated syncope.
Conclusions:
- Suspected or certain heart disease is a key predictor of cardiac syncope.
- Specific historical elements aid in predicting cardiac and neurally mediated syncope in diverse patient groups.
Objectives:
We sought to establish what historical findings are predictive of the cause of syncope.
Background:
The clinical features of the various types of syncope have not been systematically investigated.
Methods:
Three hundred forty-one patients with syncope were prospectively evaluated. Each patient was interviewed using a standard questionnaire. A cause of syncope was assigned using standardized diagnostic criteria.
Results:
A cardiac cause of syncope was established in 23% of the patients, a neurally mediated cause in 58% and a neurologic or psychiatric cause in 1%, and in the remaining 18%, the cause of syncope remained unexplained. In a preliminary analysis including age, gender and the presence of suspected or certain heart disease after the initial evaluation, only heart disease was an independent predictor of a cardiac cause of syncope (odds ratio 16, p = 0.00001), with a sensitivity of 95% and a specificity of 45%. In contrast, the absence of heart disease allowed us to exclude a cardiac cause of syncope in 97% of the patients. In patients with certain or suspected heart disease, the most specific predictors of a cardiac cause were syncope in the supine position or during effort, blurred vision and convulsive syncope. Significant and specific predictors of a neurally mediated cause were time between the first and last syncopal episode >4 years, abdominal discomfort before the loss of consciousness and nausea and diaphoresis during the recovery phase. In the patients without heart disease, palpitation was the only significant predictor of a cardiac cause.
Conclusions:
The presence of suspected or certain heart disease after the initial evaluation is a strong predictor of a cardiac cause of syncope. A few historical findings are useful to predict cardiac and neurally mediated syncope in patients with and without heart disease.