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

F/U

• Holter (heart dz suspected
• Tilt-test (heart dz not suspected)

Source

Tintinalli

UpToDate

ACEP Clinical Policy 2007