Syncope
Pearls
- 3 Questions
- Is this true syncope or something else (eg, stroke, seizure, head injury)?
- If this is true syncope, is there a clear life-threatening cause?
- 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
- Exertion preceding the event
- History of cardiac disease in the patient
- Family history of sudden death, deafness, or cardiac disease
- Recurrent episodes
- Recumbent episode
- Prolonged loss of consciousness
- Associated chest pain or palpitations
- Use of medications that can alter cardiac conduction
Work-Up
- ECG
- Urine pregnancy
- Consider:
- Hemoglobin
- Chemistry
- Orthostatics (symptomatic)
- CXR (dissection)
- Troponin
- Guaiac
DDX
Disposition
- Admit
- Abnormal ECG
- CHF
- Suspicion of structural heart disease
- HCT <30
- Shortness of breath
- SBP <90
- Family history of sudden cardiac death
- Advanced age
- Discharge
- None of the above findings (esp if age <45)
- Consider referral for holter or til-table test
Source
Tintinalli
UpToDate
ACEP Clinical Policy 2007