The Etiology of Syncope in an Emergency Hospital

Abstract

Background. Syncope is a commonly encountered problem in an emergency hospital. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients for whom syncope is a symptom of a potentially life-threatening condition.Material and methods. We identified adult patients presenting with syncope to the Emergency Department of our hospital from January 2012 to June 2014. Of 590 patients found in the hospital database we further selected 217 patients who met our criteria, namely having a positive diagnosis of syncope (being clearly distinguished from other TLOCs) and an etiology of the disease. Thus, definite diagnosis was established retrospectively by reviewing medical records.Results. The demographics of our group shows a slightly different distribution between men and women (49% men and 51% women) and a majority of the urban population (67%). As for the age range, most of our patients were in the age group of 70-80 years (30%), 29% were > 80 years old, and the percentage decreases significantly in the 60-70 years range (17%). The most frequent causes of syncope were cardiac (32%), vasovagal (23%) and due to orthostatic hypotension (12%), but we have also found various cases of mixt or iatrogenic causes.Conclusions. The incidence of syncope increases sharply after 70 years of age and poses special consideration in light of multiple comorbid conditions, age-related changes, atypical presentation, and concomitant medication use. The most common causes of syncope in this population are cardiac causes, orthostatic hypotension and carotid sinus hypersensitivity. Often, root cause of syncope remains undiagnosed, despite exhaustive diagnostic testing.

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

“…Vasovagal syncope, an autonomic neural reflex failure resulting in reduced cardiac output and cerebral hypoperfusion [20], is among the most common causes of syncope, with one study estimating 24% of syncope workups to be classified as vasovagal [20,26].…”

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

“…Nine articles reported results as part of international research [18][19][20][21][22][23][24][25][26]. Research topics included resuscitation [21,[26][27][28][29][30], cardiovascular and respiratory pathologies (syncope [31,32], acute heart failure [22], asthma [25], and dyspnoea [24,33], infectious diseases [19,20], with 1 regarding the paediatric population [19], pre-hospital [18,23], toxicology [34][35][36], trauma [37], and upper gastrointestinal bleeding [38,39].…”

Current best practices in emergency evaluation and management of syncope

“…4,5 It is characterized by a rapid onset and a short duration. 6 Syncope itself often poses a challenging case for most hospital providers, as patients are typically asymptomatic upon presentation and have a rather low rate of etiologic diagnosis. Patients with syncope frequently undergo signifi cant diagnostic testing, often with minimal diagnostic yield and thus unclear benefi t. [7][8][9][10][11] Hospitalizations for syncope average about $5,300 per admission or $2.4 billion dollars annually in the US, and often fail to identify the etiology of the syncopal episode.…”

“…4,9 Most often, the cause of syncope is benign, self-limiting, and most commonly attributed to a vasovagal response or orthostatic hypotension. 5,6,9,12,14 It is essential to initially distinguish between true syncope and other causes of transient loss of consciousness such as seizures or traumatic causes including falls or concussions. Once this determination is made, the provider must further distinguish between benign causes and potentially worrisome conditions such as cardiac or neurologic syncope.…”

“…Underlying heart disease is a signifi cant independent marker of cardiac causes of syncope with 95% sensitivity. 6,12,13 Likewise, absence of heart disease excludes a cardiac cause of syncope in 97% of patients. 12 Patients over the age of 60 are more at risk for experiencing cardiac syncope.…”