Syncope: current diagnostic evaluation and management

Article Abstract:

Syncope, or fainting, is a temporary loss of consciousness due to inadequate blood supply to the brain. The causes, criteria for diagnosis, and treatment of syncope were assessed by the authors, who utilized their clinical experience to review 200 published articles on syncope. Their review of the literature showed that syncope is a common clinical problem, affecting 30 to 50 percent of the adult population. The expected outcome of syncope depends on the cause; syncope resulting from heart disorders has the worst prognosis and requires complete evaluation and immediate treatment. Diagnosis of syncope can be difficult because of the transient nature and multiple causes of this disorder. Although noninvasive tests, or diagnostic methods which do not involve entering the body by using needles, tubes, or devices, can effectively diagnose syncope in 50 percent of cases, invasive methods have become more important in defining the cause of syncope related to abnormalities of heart structure. New diagnostic tests include: electrophysiologic studies, which test the conduction of electrical impulses along nerves and muscles; tilt-table evaluation, which involves the provocation of syncope by tilting the patient lying on a table that can be inclined at various angles; measurement of heart rate and blood pressure; and continuous monitoring of the heart electrical activity in patients while they go about their usual activities. The validity and clinical effectiveness of tests used to diagnose syncope should be investigated further. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of

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Unexplained syncope

Article Abstract:

The following guidelines provide a systematic strategy for diagnosing patients with fainting that remains unexplained after evaluating the results of a history, physical examination, and electrocardiogram. Indications and ramifications of each diagnostic modality are discussed. If the patient has heart disease or an abnormal electrocardiogram, echocardiography, exercise testing, 24-hour Holter monitoring or intracardiac electrophysiologic studies may be appropriate. Among elderly patients, carotid massage, stress tests, echocardiography, or tilt-table testing may assist in diagnosis. Among younger patients apparently free heart disease, long-term loop electrocardiography, tilt-table testing, and psychiatric evaluation may be indicated.

Tilt table

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Value of history, physical examination, and electrocardiography

Article Abstract:

The usefulness of various testing procedures on patients who have fainted is discussed. The source of many fainting episodes can be identified by performing a basic examination, taking a complete medical history and evaluating the heart's electrical activity with an electrocardiogram. More extensive heart testing may be indicated in patients who have fainted and have a history of heart disease or repeated fainting episodes. Elderly patients taking multiple medications may be at greater risk for fainting. Neurological testing may only have limited usefulness.

Evaluation, Physical diagnosis, Medical examination

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