Diagnosing syncope. With an emphasis on cardiac causes

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Syncope evaluation is often lengthy, expensive, and diagnostic rates are low.
• Prognosis is tied to underlying conditions, not syncope itself.
• Recurrent syncope does not necessarily indicate a poor prognosis.

Purpose of the Study:

• To outline the diagnostic and prognostic implications of syncope evaluation.
• To define the role of primary care physicians in initial syncope management.

Main Methods:

• Review of diagnostic approaches for syncope.
• Assessment of prognostic factors in patients with syncope.
• Evaluation of the utility of Holter monitoring, echocardiography, and signal-averaged electrocardiography.

Main Results:

• Up to 50% of syncope evaluations do not yield a diagnosis.
• Prognosis is excellent for patients with no organic heart disease and an undiagnosed cause of syncope.
• Primary care physicians can manage most initial syncope evaluations.

Conclusions:

• Initial syncope evaluation and management can be handled by primary care physicians with access to standard cardiac diagnostic tools.
• Cardiology consultation is reserved for cases with unrevealing initial evaluations or complex findings.
• A definitive diagnosis is not always necessary for a good prognosis in syncope patients without underlying heart disease.