Document Detail

Prospective evaluation of patients with syncope: a population-based study.
MedLine Citation:
PMID:  11530027     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To determine the diagnostic yield of a standardized sequential evaluation of patients with syncope in a primary care teaching hospital. PATIENTS AND METHODS: All consecutive patients who presented to the emergency department with syncope as a chief complaint were enrolled. Their evaluation included initial and routine clinical examination, including carotid sinus massage, as well as electrocardiography and basic laboratory testing. Targeted tests, such as echocardiography, were used when a specific entity was suspected clinically. Other cardiovascular tests (24-hour Holter monitoring, ambulatory loop recorder ECG, upright tilt test, and signal-averaged electrocardiography) were performed in patients with unexplained syncope after the initial steps. Electrophysiologic studies were performed in selected patients only as clinically appropriate. Follow-up information on recurrence and mortality were obtained every 6 months for as long as 18 months for 94% (n = 611) of the patients. RESULTS: After the initial clinical evaluation, a suspected cause of syncope was found in 69% (n = 446) of the 650 patients, including neurocardiogenic syncope (n = 234, 36%), orthostatic hypotension (n = 156, 24%), arrhythmia (n = 24, 4%), and other diseases (n = 32, 5%). Of the 67 patients who underwent targeted tests, suspected diagnoses were confirmed in 49 (73%) patients: aortic stenosis (n = 8, 1%), pulmonary embolism (n = 8, 1%), seizures/stroke (n = 30, 5%), and other diseases (n = 3). Extensive cardiovascular workups, which were performed in 122 of the 155 patients in whom syncope remained unexplained after clinical assessment, provided a suspected cause of syncope in only 30 (25%) patients, including arrhythmias in 18 (60%), all of whom had abnormal baseline ECGs. The 18-month mortality was 9% (n = 55, including 8 patients with sudden death); syncope recurred in 15% (n = 95) of the patients. CONCLUSION: The diagnostic yield of a standardized clinical evaluation of syncope was 76%, greater than reported previously in unselected patients. Electrocardiogram-based risk stratification was useful in guiding the use of specialized cardiovascular tests.
F P Sarasin; M Louis-Simonet; D Carballo; S Slama; A Rajeswaran; J T Metzger; C Lovis; P F Unger; A F Junod
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of medicine     Volume:  111     ISSN:  0002-9343     ISO Abbreviation:  Am. J. Med.     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-08-31     Completed Date:  2001-10-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  177-84     Citation Subset:  AIM; IM    
Medical Clinics 1 and 2 and Department of Internal Medicine, Hôpital Cantonal, University of Geneva Medical School, Geneva, Switzerland.
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MeSH Terms
Aged, 80 and over
Aortic Valve Stenosis / diagnosis
Diagnosis, Differential
Electrocardiography, Ambulatory
Hospitals, Teaching
Middle Aged
Population Surveillance
Primary Health Care
Prospective Studies
Pulmonary Embolism / diagnosis
Seizures / diagnosis
Stroke / diagnosis
Syncope / etiology*,  mortality
Tilt-Table Test
Comment In:
ACP J Club. 2002 Mar-Apr;136(2):77   [PMID:  11874302 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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