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New diagnostic modalities for the evaluation of the patient with syncope

H L Weiner1

  • 1Department of Medicine, Medical Center of Delaware.

Delaware Medical Journal
|July 1, 1991
PubMed

Insights

Cardiac syncope patients face poor prognosis and sudden death risk, often due to ventricular tachycardia. Early electrophysiology (EP) testing is crucial for diagnosing cardiac syncope and guiding treatment.

Area of Science:

  • Cardiology
  • Clinical Electrophysiology

Background:

  • Syncope is a frequent clinical issue with significant implications, especially when cardiac in origin.
  • Cardiac syncope is associated with a poor prognosis and increased risk of sudden cardiac death.
  • Ventricular tachycardia in coronary artery disease is a common cause of cardiac syncope.

Purpose of the Study:

  • To outline diagnostic strategies for syncope, differentiating cardiac from non-cardiac causes.
  • To emphasize the importance of electrophysiology (EP) testing in patients with structural heart disease and syncope.
  • To highlight the utility of specific tests like SAE and tilt testing in syncope evaluation.

Main Methods:

  • Review of diagnostic approaches for syncope.
  • Emphasis on EP testing for patients with syncope and structural heart disease.
  • Discussion of the role of the Syncope Assessment Engine (SAE) and tilt testing.
  • Recommendation for loop monitoring in undiagnosed cases.

Main Results:

  • Patients with cardiac syncope have a poor prognosis and high sudden death incidence.
  • Ventricular tachycardia is a primary concern in coronary artery disease patients with syncope.
  • Syncope in patients with normal hearts often indicates neurally mediated syncope, diagnosable by tilt testing.
  • Approximately 30% of patients with syncope and a normal heart experience recurrent episodes.

Conclusions:

  • EP testing is essential for patients with syncope and structural heart disease to rule out ventricular tachycardia.
  • SAE may aid in identifying patients likely to have ventricular tachycardia at EP testing.
  • Neurally mediated syncope is common in patients with normal hearts and can be diagnosed with tilt testing.
  • Loop monitoring is recommended for syncope cases that remain undiagnosed after initial evaluation.

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