We prospectively evaluated and followed 204 patients with syncope to determine how often a cause of syncope could be established and to define the prognosis of such patients. A cardiovascular cause was established in 53 patients and a noncardiovascular cause in 54. The cause remained unknown in 97 patients. At 12 months, the overall mortality was 14 +/- 2.5 per cent. The mortality rate (30 +/- 6.7 per cent) in patients with a cardiovascular cause of syncope was significantly higher than the rate (12 +/- 4.4 per cent) in patients with a noncardiovascular cause (P = 0.02) and the rate (6.4 +/- 2.8 per cent) in patients with syncope of unknown origin (P less than 0.0001). The incidence of sudden death was 24 +/- 6.6 per cent in patients with a cardiovascular cause, as compared with 4 +/- 2.7 per cent in patients with a noncardiovascular cause (P = 0.005) and 3 +/- 1.8 per cent in patients with syncope of unknown origin (P = 0.0002). Patients with syncope can be separated into diagnostic categories that have prognostic importance. Patients with a cardiovascular cause have a strikingly higher incidence of sudden death than patients with a noncardiovascular or unknown cause.

No abstract

The records of 121 patients hospitalized in Presbyterian-University Hospital, Pittsburgh, during 1976 to 1980 for syncope of unknown origin were reviewed. The were 58 men and 63 women, whose mean age was 63.1 years. Cardiac monitoring in 67 patients showed abnormalities in seven patients, considered diagnostic of the cause of syncope. In 13 patients with electrophysiologic studies, four patients had abnormal results, suggesting a probable cause for the syncope. Cardiac catheterization in 14 patients showed significant findings that demonstrated the cause of syncope in three patients. Glucose tolerance tests in 37 patients, head computed tomographic scans in 39 patients, radionuclide brain scans in 15 patients, lumbar punctures in 22 patients, and skull roentgenograms in 46 patients did not aid in the diagnosis of the cause of syncope in any patient. In 67 patients, EEGs produced abnormal results in 26, but the role of EEGs in the diagnostic workup of syncope could not be completely defined. The definitive cause for syncope was diagnosed in only 13 of 121 patients, with an average hospitalization of nine days and an average cost of $2,463 per patient. These findings suggest that an extensive evaluation of syncope is cost--ineffective and that prospective goal-directed approaches need to be developed.

No abstract

Hyperthyroid disease can be treated definitively for most patients. Palliative therapy with beta-adrenergic blockade is useful in some patients. Further studies are needed to determine whether more recently described treatments have improved efficacy and whether therapy directed specifically at the underlying immunologic cause of Graves disease can be used successfully.