Key Points
- To review evolving evidence-based recommendations for diagnosing and managing syncope in a clinically and cost-effective manner.
- Searched the Medline database from January 1996 to April 2006 using MeSH terms related to syncope, diagnostic imaging, and cardiac arrhythmias.
- Reviewed English-language trials, reference bibliographies, and practice guidelines published by the Heart Rhythm Society, American Heart Association, and American College of Cardiology.
- A standard initial evaluation combining clinical history, physical examination, and a 12-lead electrocardiogram accurately identifies the majority of high-risk patients.
- Ventricular arrhythmias represent the primary etiology in patients with structural heart disease, and an ejection fraction below 30% indicates the need for an implantable cardioverter-defibrillator.
- Patients lacking structural heart disease generally exhibit low mortality risk and can be managed conservatively for neurocardiogenic syncope once inherited arrhythmogenic conditions are excluded.
Structured PICO
PPopulationPatients presenting with syncope
IInterventionMethodical diagnostic and management approach (including history, physical exam, ECG, echocardiogram, and targeted therapies like ICDs)
OOutcomeAccurate diagnosis and risk stratification of syncope
A methodical approach to syncope evaluation, centered on history, physical exam, ECG, and assessment of structural heart disease, is essential for effective management and risk stratification.