Syncope and Evaluation

Syncope, a brief self-limited transient loss of consciousness, is a relatively common occurrence in the general population with a variety of underlying causes. It is associated with:

• 1% to 6% of hospital medical admissions¹
• 3% of emergency room visits each year²
• 740,000 Emergency Department syncope cases per year in the United States³
• Overall admissions rate of 32%³
• $700 million in secondary trauma, including approximately 10% of falls in the elderly⁴

While the underlying cause of syncope can often be determined and appropriate treatment chosen, as many as 47% of all cases of syncope episodes are unexplained.⁵

Findings from the Framingham Heart Study population suggest additional diagnostic testing and evaluation of unexplained syncope may be advised. A review of over 7,800 patients showed that those with unexplained and cardiac syncope were at increased risk of death.⁶ In fact, those with:

• Cardiac syncope had a 6-month mortality rate of greater than 10%⁶
• Cardiac syncope had double the risk of death⁶

Evaluation of Syncope

Diagnosing unexplained syncope can be challenging and frustrating. The following flowchart provides a general protocol to assist in the diagnostic process. An insertable cardiac monitor may help confirm or rule out life-threatening arrhythmias as the cause of recurrent but infrequent fainting.

References

1. Kapoor W. Medicine. 1990;69:160-175.
2. Day SC, et al. Am J Med. 1982;73:15-23.
3. Sun BC, et al. Acad Emerg Med. 2004;11(10)1029-1034.
4. Grubb BP, Olshansky B, eds. 2nd. Blackwell Publishing; 2005.
5. Silverstein MD, et al. JAMA. 1982;248:1185-1189.
6. Soteriades ES, et al. N Engl J Med. 2000;347:878-885.

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