Related Experiment Video

Updated: Jul 3, 2026

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
10:17

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Published on: April 11, 2025

Effectiveness of a new diagnostic algorithm for the diagnosis of unexplained syncope in patients with hypertrophic

M Rafanelli1, S Agusto1, C Fumagalli2

  • 1Syncope Unit, Department of Geriatric Cardiology and Intensive Care, Careggi University Hospital, Florence, Italy.

International Journal of Cardiology
|July 1, 2026
PubMed

Insights

A new diagnostic algorithm successfully identified the cause of syncope in nearly 90% of hypertrophic cardiomyopathy (HCM) patients. This structured approach aids in preventing sudden cardiac death (SCD) and optimizing risk stratification.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Hypertrophic cardiomyopathy (HCM) poses a risk of sudden cardiac death (SCD) in patients experiencing unexplained syncope.
  • Identifying the cause of syncope is critical for effective management and prevention of SCD in HCM patients.

Purpose of the Study:

  • To evaluate the effectiveness of a novel stepwise diagnostic algorithm for assessing the causes of syncope in a cohort of HCM patients.
  • To determine if the algorithm improves etiological diagnosis and risk stratification.

Main Methods:

  • A retrospective analysis of consecutive HCM patients with unexplained syncope was performed.
  • A stepwise diagnostic algorithm including initial evaluation, autonomic testing, and implantable loop recorders was applied.
  • Data were collected from patients referred to specialized units between May 2004 and July 2024.

Main Results:

  • The algorithm established a diagnosis in 88.3% of 43 HCM patients.
  • Initial evaluation identified hypotensive or arrhythmic causes in 51.2% of cases.
  • Autonomic assessment and implantable loop recorders provided diagnoses in 25.5% and 15.3% of relevant cases, respectively.

Conclusions:

  • A structured, stepwise diagnostic approach is highly effective in determining the cause of syncope in HCM patients.
  • This method can optimize long-term risk stratification and potentially reduce unnecessary device implantation.
  • No sudden cardiac deaths occurred during the follow-up period in patients diagnosed using the algorithm.
Abstract

Related Concept Videos

Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Dysrhythmias V: Evaluating Dysrhythmias01:30

Dysrhythmias V: Evaluating Dysrhythmias

Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...