Syncope: a retrospective study of 101 hospitalized patients

A retrospective study was conducted of 101 hospitalized patients who had one or more episodes of syncope. The etiology of syncope was established with relative ease in 61% of these patients. History and physical examination revealed the cause in 34%, resting ECG in 11% and 24-h ECG monitoring in 16%. Additional tests (electroencephalograms, Doppler studies of the cervical arteries, computerized tomography of the brain, ultrasonography of the heart and cardiac catheterization) either were noncontributory or did not contribute to confirmed diagnoses already established by other means. Cardiac causes were responsible for the syncope in 34% and noncardiac causes in 27%. Comparison between diagnosed and undiagnosed patients revealed no significant differences with respect to age, number of syncopal episodes or presence of hypertension or diabetes. There were, however, significantly more women, and a lower frequency of ischemic heart disease and other associated diseases in the undiagnosed group. It is concluded that all patients with syncope should undergo ambulatory ECG and 24-h ECG monitoring, and that hospitalization should be reserved for patients whose clinical condition requires admission or when further investigation is necessary.