Current concepts in the evaluation and management of syncope

Abstract

Syncope is a very common presentation with a wide differential diagnosis and equally wide prognostic implications. Recent work has highlighted the importance of an accurate history and physical examination as the basis of diagnosis, prognosis, and treatment. Several centers have evaluated the role of structured histories and comprehensive syncope evaluation guidelines and units in managing syncope. Although these do provide comprehensive care, whether they improve overall outcome and reduce costs is far from clear. This is partly because there are few effective treatments for the major cause of fainting, vasovagal syncope. Recent randomized trials have highlighted the roles of physical counterpressure maneuvers and midodrine and the limitations of treatment with beta blockers and permanent cardiac pacing.

Postural Tachycardia Syndrome and Reflex Syncope: Similarities and Differences

“…13 This is beyond the scope of the present review, which focuses exclusively on orthostatic intolerance. POTS is identified with chronic orthostatic intolerance 14-16 and is defined operationally by symptoms of OI in association with excessive tachycardia.…”

Method of Pacing Does Not Affect the Recurrence of Syncope in Carotid Sinus Syndrome

“…This data correlates with prior observational and small prospective randomized trials that have demonstrated pacemaker therapy efficacy in reducing recurrent syncope in the elderly. [18][19][20][21] Historically, however, unblinded trials in the therapy of syncope have provided divergent results, 22 reinforcing the need for large doubleblinded randomized approaches in this field. These results should also, however, be seen in the context of the Safepace 2 trial, 23 which, although double-blinded (yet underpowered), did only show a trend toward benefit with pacing versus implantable loop recording.…”