Syncope and Structural Heart Disease: Historical Criteria for Vasovagal Syncope and Ventricular Tachycardia

Abstract

the causes of syncope in patients with SHD, and their clinical outcomes, can be estimated accurately based on the clinical history. The history safely screens out the possibility of VT as a cause of syncope.

Syncope in Patients with Organic Heart Disease

“…Using these criteria, 92% were classified correctly (negative predictive value !96%), diagnosing ventricular tachycardia with 99% sensitivity and 68% specificity. 62 The 9-year arrhythmia-free and total survival was predicted from the history, but even low risk does not mean no risk. 63 In another study of 1060 consecutive patients with presumed vasovagal syncope, patients older than 60 years were less likely to give a typical history, more likely to present with unexplained falls, and less likely to have episodes triggered by prolonged standing (OR 0.55, 95% CI 0.40-0.72), posture change (OR 0.61, 95% CI 0.46-0.82), or hot environments (OR 0.57, 95% CI 0.42-0.78).…”

How to Differentiate Syncope from Seizure

“…10,18,34 The cause of loss of consciousness was known in 539 patients (according to gold standard criteria), and included various types of epilepsy, vasovagal syncope, and cardiac arrhythmias. The point score ( Table 4) distinguished between syncope and seizures 10 with a sensitivity of 94% and a specificity of 94%.…”

Recurrent syncope: differential diagnosis and management

“…A description of the TLOC from a witness, although not always available, may be complementary. The Calgary Syncope Score is a series of validated structured simple questionnaires to assist bedside clinicians in differentiating seizure from syncope, and vasovagal syncope from cardiac syncope 10 11. The reader is directed to use these simplified tools at the point of care to assist in directing the need for hospital admission or ambulatory investigations, particularly the 7-point questionnaire in the original paper 11…”