[Differential Diagnostics of Unclear Syncope]

Overview

Journal Herz

Specialty Cardiology & Vascular Diseases

Date 2019 Oct 18

PMID 31620824

Authors

T Seewoster

F Lindemann

G Hindricks

Affiliations

Soon will be listed here.

Abstract

The clarification of syncope is a diagnostic challenge as possible causes often occur only intermittently. Therefore, a detailed and standardized anamnesis is essential as it 1) differentiates syncope from other transient losses of consciousness (TLOC) and 2) directly clarifies possible causes of syncope. The risk stratification plays a central and very important role in order to avoid unnecessary examinations in patients with benign syncope and to provide patients with life-threatening, mostly cardiac syncopal episodes with timely diagnostics and treatment. In cases where the cause of syncope is still unclear, a standardized approach is indicated using extended diagnostics, such as a tilt table examination, a carotid sinus pressure test, prolonged telemetric monitoring or clarification with an implantable loop recorder (ILR).

References

Ungar A, Rivasi G, Rafanelli M, Toffanello G, Mussi C, Ceccofiglio A . Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians. Age Ageing. 2016; 45(2):242-8. DOI: 10.1093/ageing/afw004. View

Canzoniero J, Afshar E, Hedian H, Koch C, Morgan D . Unnecessary hospitalization and related harm for patients with low-risk syncope. JAMA Intern Med. 2015; 175(6):1065-7. DOI: 10.1001/jamainternmed.2015.0945. View

Locati E, Moya A, Oliveira M, Tanner H, Willems R, Lunati M . External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: results of the SYNARR-Flash study. Europace. 2015; 18(8):1265-72. PMC: 4974630. DOI: 10.1093/europace/euv311. View

Quinn J, McDermott D, Stiell I, Kohn M, Wells G . Prospective validation of the San Francisco Syncope Rule to predict patients with serious outcomes. Ann Emerg Med. 2006; 47(5):448-54. DOI: 10.1016/j.annemergmed.2005.11.019. View

Da Costa A, Defaye P, Romeyer-Bouchard C, Roche F, Dauphinot V, Deharo J . Clinical impact of the implantable loop recorder in patients with isolated syncope, bundle branch block and negative workup: a randomized multicentre prospective study. Arch Cardiovasc Dis. 2013; 106(3):146-54. DOI: 10.1016/j.acvd.2012.12.002. View

Podoleanu C, DaCosta A, Defaye P, Taieb J, Galley D, Bru P . Early use of an implantable loop recorder in syncope evaluation: a randomized study in the context of the French healthcare system (FRESH study). Arch Cardiovasc Dis. 2014; 107(10):546-52. DOI: 10.1016/j.acvd.2014.05.009. View

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O . 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm.... Europace. 2013; 15(8):1070-118. DOI: 10.1093/europace/eut206. View

Davies A, Kenny R . Frequency of neurologic complications following carotid sinus massage. Am J Cardiol. 1998; 81(10):1256-7. DOI: 10.1016/s0002-9149(98)00130-1. View

Munro N, McIntosh S, Lawson J, Morley C, Sutton R, Kenny R . Incidence of complications after carotid sinus massage in older patients with syncope. J Am Geriatr Soc. 1994; 42(12):1248-51. DOI: 10.1111/j.1532-5415.1994.tb06505.x. View

10.

Middlekauff H, STEVENSON W, Stevenson L, Saxon L . Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope. J Am Coll Cardiol. 1993; 21(1):110-6. DOI: 10.1016/0735-1097(93)90724-f. View

11.

Goodwin E, Kandler R, Alix J . The value of home video with ambulatory EEG: a prospective service review. Seizure. 2014; 23(6):480-2. DOI: 10.1016/j.seizure.2014.02.008. View

12.

Brignole M, Menozzi C, Moya A, Andresen D, Blanc J, Krahn A . Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation. 2012; 125(21):2566-71. DOI: 10.1161/CIRCULATIONAHA.111.082313. View

13.

Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick A . Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J Am Coll Cardiol. 2000; 36(1):181-4. DOI: 10.1016/s0735-1097(00)00700-2. View

14.

Sau A, Taraborrelli P, Moore P, Lim P . Cardioinhibitory and vasodepressor responses to different stressors on head-up tilt. Europace. 2017; 20(1):115. DOI: 10.1093/europace/eux018. View

15.

Brignole M, Moya A, de Lange F, Deharo J, Elliott P, Fanciulli A . Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018; 39(21):e43-e80. DOI: 10.1093/eurheartj/ehy071. View

16.

Krahn A, Klein G, Yee R, Skanes A . Randomized assessment of syncope trial: conventional diagnostic testing versus a prolonged monitoring strategy. Circulation. 2001; 104(1):46-51. DOI: 10.1161/01.cir.104.1.46. View

17.

Brignole M, Gianfranchi L, Menozzi C, Raviele A, Oddone D, LOLLI G . Role of autonomic reflexes in syncope associated with paroxysmal atrial fibrillation. J Am Coll Cardiol. 1993; 22(4):1123-9. DOI: 10.1016/0735-1097(93)90426-2. View

18.

Whittaker R . Video telemetry: current concepts and recent advances. Pract Neurol. 2015; 15(6):445-50. DOI: 10.1136/practneurol-2015-001216. View

19.

Sutton R, Brignole M . Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis. Eur Heart J. 2014; 35(33):2211-2. DOI: 10.1093/eurheartj/ehu255. View

20.

de Ruiter S, Wold J, Germans T, Ruiter J, Jansen R . Multiple causes of syncope in the elderly: diagnostic outcomes of a Dutch multidisciplinary syncope pathway. Europace. 2017; 20(5):867-872. DOI: 10.1093/europace/eux099. View