Syncope: Epidemiology, Prognosis and Diagnostic Evaluation

Francis E. Marchlinski, M.D., F.A.C.C.
Disclosures		Relationship: Yes Grants/Research Support: Cordis Webster Biosense and Boston Scientific Other Support: Performs clinical investigation for Cordis Webster Biosense and Boston Scientific

Edward P. Gerstenfeld, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Edward P. Gerstenfeld, MD, is an assistant professor of medicine; and Francis E. Marchlinski a professor of medicine at the University of Pennsylvania School of Medicine. Here, they discuss the epidemiology and prognosis for different types of syncope, and the strength and limitations of various diagnostic tests for syncope.

The authors define syncope and discuss its prevalence, noting the difficulty of establishing a clear diagnosis because of the multitude of available tests. Neurocardiogenic, mechanical cardiac disease, arrhythmia, orthostatic, neurologic, or psychiatric causes of syncope are discussed with aortic stenosis, hypertrophic obstructive myopathy, and mitral stenosis in syncope being the main cardiac causes.

The authors discuss the differing prognoses for vasovagal syncope and for cardiac or neurologic syncope, and emphasize that, despite the many available sophisticated diagnostic tests for syncope, the patient history is still the most important aspect of evaluation ... and the physical exam is particularly informative. Even so, they recommend a 12-lead EKG for all patients and they provide several illustrated examples of patients undergoing these diagnostic tests.

The lecture continues with a discussion of Holter monitors and External loop monitors in syncope. Treatment includes liberalization of salt and fluid intake, and pharmacologic agents include salt tablets, fludricortisone and midodrine in syncope.

Postural orthostatic tachycardia syndrome, and the sometimes sensational event involving syncope and the athlete, particularly sudden death in young sports players, conclude the lecture, which is well illustrated.