1.History, physical examination, and electrocardiography are the core of
the syncope workup (combined diagnostic yield,
50%).
2. Neurologic testing is rarely helpful unless additional neurologic signs or symptoms are present (diagnostic yield of electroencephalography, computed tomography, and Doppler ultrasonography, 2% to 6%).
3. Patients in whom heart disease is known or suspected or those with exertional syncope are at higher risk for adverse outcomes and should have cardiac testing, including echocardiography, stress testing, Holter monitoring, or intracardiac electrophysiologic studies, alone or in combination (diagnostic yields, 5% to 35%). 4. Syncope in the elderly often results from polypharmacy and abnormal physiologic responses to daily events. 5. Long-term loop electrocardiography (diagnostic yield, 25% to 35%) and tilt testing (diagnostic yield ≤ 60%) are most useful in patients with recurrent syncope in whom heart disease is not suspected.
6. Psychiatric evaluation can detect mental disorders associated with syncope in up to 25% of cases.
7. Hospitalization may be indicated for patients at high risk for cardiac syncope (those with an abnormal electrocardiogram, organic heart disease, chest pain, history of arrhythmia, age >70 years) or with acute neurologic signs. ( source: Annals of Internal Medicine vol. 126 no. 12 989-996)
2. Neurologic testing is rarely helpful unless additional neurologic signs or symptoms are present (diagnostic yield of electroencephalography, computed tomography, and Doppler ultrasonography, 2% to 6%).
3. Patients in whom heart disease is known or suspected or those with exertional syncope are at higher risk for adverse outcomes and should have cardiac testing, including echocardiography, stress testing, Holter monitoring, or intracardiac electrophysiologic studies, alone or in combination (diagnostic yields, 5% to 35%). 4. Syncope in the elderly often results from polypharmacy and abnormal physiologic responses to daily events. 5. Long-term loop electrocardiography (diagnostic yield, 25% to 35%) and tilt testing (diagnostic yield ≤ 60%) are most useful in patients with recurrent syncope in whom heart disease is not suspected.
6. Psychiatric evaluation can detect mental disorders associated with syncope in up to 25% of cases.
7. Hospitalization may be indicated for patients at high risk for cardiac syncope (those with an abnormal electrocardiogram, organic heart disease, chest pain, history of arrhythmia, age >70 years) or with acute neurologic signs. ( source: Annals of Internal Medicine vol. 126 no. 12 989-996)
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