Syncope

Pearls

• 3 Questions

1. Is this true syncope or something else (eg, stroke, seizure, head injury)?
2. If this is true syncope, is there a clear life-threatening cause?
3. If this is true syncope and the cause is not clear, is the pt at high risk?

• Cardiac syncope usually occurs w/o warning
• TIA unlikely if no other s/s before or after
• In elderly think MI until proven otherwise

Work-Up

1. ECG
2. Urine pregnancy
3. Consider:
   1. Hemoglobin
   2. Chemistry
   3. Orthostatics (symptomatic)
   4. CXR (dissection)
   5. Troponin
   6. Guaiac

DDX

Syncope (DDx)

Disposition

• Admit

1. Abnormal ECG
2. CHF
3. Suspicion of structural heart disease
4. HCT <30
5. Shortness of breath
6. SBP <90
7. Family history of sudden cardiac death
8. Advanced age

• Discharge

1. None of the above findings (esp if age <45)
2. Consider referral for holter or til-table test

Source

Tintinalli

UpToDate

ACEP Clinical Policy 2007