[Evaluation of high risk syncope referred from emergency department]

High-risk syncope (over aged 60, abnormal electrocardiogram, syncope without prodromes and/or background of cardiovascular disease) is associated with high mortality. More detailed attention to that which may often be considered as an emergency should be given. We have evaluated the activity of a specialized service in the care of syncope in an internal medicine service.

We have collected a series of patients diagnosed in the emergency service of "syncope." The patients were referred to the specialized unit in the care of syncope and evaluated in less than 72h. We analyzed the tests made to establish a pathophysiological diagnosis of syncope.

A total of 107 consecutive patients were studied, 82 of whom met the criteria for being at risk of syncope. All underwent an echocardiography and outpatient Holter. A total of 23 studies were performed with tilt test, 4 electrophysiological studies were performed and 2 were implanted with an insertable Holter. A specific diagnosis could be established in 73 patients. Three patients were diagnosed with a neurological disease. The most frequent cause of the syncope was neuromediated (41 patients). After a mean follow-up of over 2 years, total mortality (9 patients) was not related with the syncope.

A specialized service in the care of high-risk syncope increases the percentage of patients with a definitive diagnosis.