Different Types of Syncope Presenting to Clinic: Do We Miss Cardiac Syncope?

Al-Busaidi, Ibrahim Saleh; Jardine, David L.

doi:10.1016/j.hlc.2019.09.008

Cited by 4 publications

(16 citation statements)

References 27 publications

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“…[1][2][3] Syncope is defi ned as a transient loss of consciousness typically caused by decreased blood flow to the brain followed by complete recovery. 4,5 It is characterized by a rapid onset and a short duration. 6 Syncope itself often poses a challenging case for most hospital providers, as patients are typically asymptomatic upon presentation and have a rather low rate of etiologic diagnosis.…”

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confidence: 99%

“…4,9 Most often, the cause of syncope is benign, self-limiting, and most commonly attributed to a vasovagal response or orthostatic hypotension. 5,6,9,12,14 It is essential to initially distinguish between true syncope and other causes of transient loss of consciousness such as seizures or traumatic causes including falls or concussions. Once this determination is made, the provider must further distinguish between benign causes and potentially worrisome conditions such as cardiac or neurologic syncope.…”

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confidence: 99%

“…12 ■ Evidence-based clinical practice recommendations Current guidelines suggest that the initial workup for patients with syncope should include a complete history and physical exam, orthostatic BP measurement, and an ECG. 4,5,8,[10][11][12]14,18 Health history alone can provide a reasonable explanation of syncopal episodes in 40% to 70% of cases, especially in cases of refl ex syncope or orthostatic hypotension. 4,5,12,14 During the history, the NP should inquire about the details of the syncopal event and assess for associated symptoms including chest pain, shortness of breath, and abdominal complaints.…”

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confidence: 99%

“…4,5,8,[10][11][12]14,18 Health history alone can provide a reasonable explanation of syncopal episodes in 40% to 70% of cases, especially in cases of refl ex syncope or orthostatic hypotension. 4,5,12,14 During the history, the NP should inquire about the details of the syncopal event and assess for associated symptoms including chest pain, shortness of breath, and abdominal complaints. This should include how many syncopal episodes they have experienced, and the amount of time they have been experiencing them.…”

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confidence: 99%

“…17 Older patients typically require further evaluation following syncopal episodes, as additional diagnostics are often indicated including cardiac workups with continuous ECG and BP monitoring, and evaluation of medication changes. 5 Advanced age and cardiovascular comorbidities are independent predictors for poor outcomes, and thus admission. 13,17 ■ Risk stratifi cation Risk stratifi cation schemes have been suggested to aid in clinical decision-making.…”

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Current best practices in emergency evaluation and management of syncope

Geer¹

2021

The Nurse Practitioner

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The Nurse Practitioner • August 2021 25 yncope is a common complaint among patients seeking immediate medical care in a multitude of different settings. In the ED alone, syncope accounts for approximately 740,000 visits annually with up to 460,000 of these patients being admitted or placed in observation. [1][2][3] Syncope is defi ned as a transient loss of consciousness typically caused by decreased blood flow to the brain followed by complete recovery. 4,5 It is characterized by a rapid onset and a short duration. 6 Syncope itself often poses a challenging case for most hospital providers, as patients are typically asymptomatic upon presentation and have a rather low rate of etiologic diagnosis. Patients with syncope frequently undergo signifi cant diagnostic testing, often with minimal diagnostic yield and thus unclear benefi t. [7][8][9][10][11] Hospitalizations for syncope average about $5,300 per admission or $2.4 billion dollars annually in the US, and often fail to identify the etiology of the syncopal episode. 1,4,8,[11][12][13] ■ Clinical predictors for syncope Syncope can result from a number of different causes, including a vasovagal response, orthostatic hypotension, cardiac abnormalities, medication issues, neurologic ailments, or even idiopathic causes. 4,9 Most often, the cause of syncope is benign, self-limiting, and most commonly attributed to a vasovagal response or orthostatic hypotension. 5,6,9,12,14 It is essential to initially distinguish between true syncope and other causes of transient loss of consciousness such as seizures or traumatic causes including falls or concussions. Once this determination is made, the provider must further distinguish between benign causes and potentially worrisome conditions such as cardiac or neurologic syncope. 4,12,14 Most morbidity and mortality associated with syncope is related to cardiac causes. 12,14 Refl ex or neurally-mediated syncope is typically defi ned as syncope occurring in the absence of heart disease or trauma caused by exposure to an unpleasant circumstance. 12,15,16 Vasovagal syncope is the most common type of refl ex syncope and may occur in situations such as prolonged sitting or standing especially in hot or crowded places or following sudden exposure to pain or unpleasant sights, sounds, emotions, or smells. Refl ex syncope can also occur with head rotation or carotid sinus pressure due to tight collars, neck ties, or tumors, or after eating or

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confidence: 99%