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

Risk Factors for Serious Cause

1. Exertion preceding the event
2. History of cardiac disease in the patient
3. Family history of sudden death, deafness, or cardiac disease
4. Recurrent episodes
5. Recumbent episode
6. Prolonged loss of consciousness
7. Associated chest pain or palpitations
8. Use of medications that can alter cardiac conduction

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