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Syncope: etiology and diagnostic approach

Elias B Hanna1

  • 1Assistant Professor of Medicine, Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans ehanna@lsuhsc.edu.

Cleveland Clinic Journal of Medicine
|December 3, 2014
PubMed

Insights

Syncope, or fainting, has three main types. Patients without structural heart disease generally have normal long-term survival, making heart health crucial for prognosis.

Area of Science:

  • Cardiology
  • Neurology

Background:

  • Syncope, characterized by temporary loss of consciousness, presents in three primary forms: neurally mediated, orthostatic hypotensive, and cardiac.
  • Cardiac syncope is the most concerning type, while neurally mediated syncope is the most frequent.

Purpose of the Study:

  • To outline the diagnostic approach for unexplained syncope based on the presence or absence of underlying heart disease.
  • To highlight the prognostic significance of structural heart disease in syncope patients.

Main Methods:

  • Review of existing studies on syncope and its correlation with long-term survival and cardiac conditions.
  • Categorization of diagnostic workup strategies tailored to patient cardiac status.

Main Results:

  • Absence of structural heart disease in syncope patients correlates with a normal long-term survival rate.
  • Structural heart disease is identified as the most critical predictor of mortality and ventricular arrhythmias.

Conclusions:

  • The diagnostic pathway for syncope is contingent upon the presence or absence of cardiac disease.
  • Electrophysiologic studies are indicated for patients with heart disease, while tilt-table testing is used for those without.
  • Prolonged rhythm monitoring serves as a valuable tool for unexplained syncope in both patient groups.

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