Clinical history in management of suspected syncope: A powerful diagnostic tool

Sutton, Richard; Dijk, Nynke van; Wieling, Wouter

doi:10.5603/cj.2014.0097

Cited by 35 publications

(56 citation statements)

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“…4) [9, 10, 22]. The effect of buttock clenching on complaints during long-term follow-up can thereby be used as the reference that the diagnosis of IOH is correct [23–25]. This emphasizes an important aspect of laboratory testing, namely the effects of physical counterpressure maneuvers can be demonstrated to the patient on a video screen [22].…”

Section: Discussionmentioning

confidence: 99%

Initial orthostatic hypotension in teenagers and young adults

et al. 2016

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ObjectiveTo assess: (1) the frequency of an abnormally large fall in blood pressure (BP) upon standing from supine in patients with initial orthostatic hypotension (IOH); (2) the underlying hemodynamic mechanisms of this fall in BP upon standing from supine and from squatting.MethodsIn a retrospective study of 371 patients (≤30 years) visiting the syncope unit, the hemodynamic response to standing and squatting were studied in 26 patients who were diagnosed clinically with IOH, based on history taking only. In six patients changes in cardiac output (CO) and systemic vascular resistance (SVR) were determined, and the underlying hemodynamics were analyzed.Results15/26 (58 %) patients with IOH had an abnormally large initial fall in systolic BP (≥40 mmHg). There was a large scatter in CO and SVR response after arising from supine [ΔCO at BP nadir median −8 % (range −37, +27 %); ΔSVR at BP nadir median −31 % (range −46, +10 %)]. The hemodynamic response after squatting showed a more consistent pattern, with a fall in SVR in all six patients [ΔCO at BP nadir median +23 % (range −12, +31 %); ΔSVR at BP nadir median −42 %, (range −52, −35 %)].InterpretationThe clinical diagnosis of IOH is based on history taking, as an abnormally large fall in systolic BP can only be documented in 58 %. For IOH upon standing after supine rest, the hemodynamic mechanism can be either a large fall in CO or in SVR. For IOH upon arising from squatting a large fall in SVR is a consistent finding.

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Section: Discussionmentioning

confidence: 99%

Initial orthostatic hypotension in teenagers and young adults

et al. 2016

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“…This uncertainty is particularly true for syncope because it is a symptom, not a disease, and episodes are rarely observed by physicians. The diagnosis is therefore usually presumptive and life-threatening events such as cardiac arrhythmias and epileptic seizures have to be considered [1,4,7]. Because there is often a small possibility of a serious cause of syncope, it can be a challenge to help the patient not to be overwhelmed by this.…”

Section: Medicine Is More Than Sciencementioning

confidence: 99%

“…Standardized approaches, including guideline pathways, risk rules, and checklists, can be helpful to identify dangerous causes of T-LOC in the emergency setting [6,7,41]. These tools are particular effective in training novices.…”

Section: Narrative Evidence-based Medicinementioning

confidence: 99%

“…Experience and pattern recognition are highly important just as, for example for a seasoned car mechanic. Expert history taking in patients with unexplained syncope is a powerful diagnostic test [6,7].…”

Section: The Futurementioning

confidence: 99%

“…The information presented stems from combining numerous papers on this subject with experience of thousands of patients presenting to our respective syncope clinics. The importance of using history taking as a diagnostic tool in patients with suspected syncope has been addressed previously [6,7] and will not be discussed in detail here.…”

Section: Introductionmentioning

confidence: 99%

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