Evaluation of Syncope and Palpitations in Women

Abstract

Syncope and palpitations are common complaints that all physicians confront during daily clinical practice. Single center and multicenter cohort studies have found that syncope accounts for 1%-3% of emergency department evaluations and that palpitations are the primary symptom for approximately 16% of patients who arrive at an outpatient clinic with a cardiac complaint. For both conditions, women make up approximately 60% of the cohorts. In general, the evaluation of both syncope and palpitations can be challenging because of the heterogeneity of causes and, consequently, the variability of clinical outcomes, ranging from a single isolated event with no effect on morbidity and mortality to the first sign of a potentially life-threatening problem and sudden cardiac death. For all women with syncope or palpitations, the history, physical examination, and a baseline electrocardiogram (ECG) form the basis of the initial workup and focus on identifying patients with cardiovascular abnormalities who are at the highest risk for sudden cardiac death. More advanced tests must be chosen using a problem-specific approach, but generally, documentation of the cardiac rhythm during symptoms is critical for all patients with syncope or palpitations. Although the diagnostic testing strategy is generally similar for men and women, gender-related differences in treatment response have been identified. Antiarrhythmic medications, such as dofetilide and sotalol, that prolong the QT interval are more likely to be associated with proarrhythmia in women. In addition, higher complication rates for invasive cardiac procedures, such as device implantation, are observed in women.

Palpitations across the menopause transition in SWAN: trajectories, characteristics, and associations with subclinical cardiovascular disease

“…An analysis of screening data from 868 predominantly White women enrolled in the Kronos Early Estrogen Prevention Study found no significant associations between palpitations (measured as severity) and CIMT ( P = 0.817) or coronary artery calcium scores ( P = 0.091). 9 In the general population, palpitations are the second leading reason for cardiologist visits, 51 account for 16% of primary care visits, 51 and are more likely to be reported by women than men during outpatient or emergency department visits 52 and during an acute cardiac event. 53,54…”

“Quick flutter skip”: midlife women's descriptions of palpitations

“…The team developed the interview guide after a thorough review of common assessment tools used to measure palpitations, literature on the common manifestations of palpitations, and clinical management recommendations. 5,9,10 Using the guide, the interviewer asked participants to describe their palpitations along eight dimensions as is common in a standard nursing symptom assessment (eg, quality, frequency, severity, distress, duration and temporal pattern, aura, associated symptoms, and aggravating/ alleviating factors). The interviewer then asked participants about any healthcare experiences (provider contacts, discussions, referrals, laboratory, or other tests) they had related to their palpitations.…”

Correlates of palpitations during menopause: A scoping review

“…In the general population, palpitations account for 16% of primary care visits and are the second leading reason for cardiologist visits. 10 Women are more likely than men to report palpitations during outpatient visits, 11 emergency department visits, 11 and during acute cardiac events. 12 , 13 However, there has been a historical and well-documented bias against women in cardiology with poor understanding and/or trivialization of symptoms, such as palpitations, that results in missed or delayed diagnosis of cardiac events.…”