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Syncope: Difference between revisions
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==Clinical features== | ==Clinical features== | ||
History taking is the most important feature in syncope evaluation. | History taking is the most important feature in syncope evaluation. Adequate history taking reveals the clinical features associated with a syncopal event that are important to differentiate the different causes of syncope. | ||
These clinical features are suggestive for a specific cause of syncope: | |||
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When the mechanism of syncope remains unclear after full evaluation, an implantable loop recorder is indicated in patients who have clinical or ECG features suggesting arrhythmic syncope. | In all patients presenting to a physician with syncope in the hospital an ECG is recommended to screen for a cardiac cause of syncope. Holter monitoring is indicated only in patients who have very frequent syncopes or presyncope. In-hospital monitoring (in bed or telemetric) is warranted only when the patient has important structural heart disease and is at high risk of life-threatening arrhythmias. In >60% a certain or highly likely diagnosis is made after initial evaluation (history taking, physical examination and ECG). | ||
When the mechanism of syncope remains unclear after full evaluation, including a head-up tilt test and carotis sinus massage, an implantable loop recorder is indicated in patients who have clinical or ECG features suggesting arrhythmic syncope. | |||
==Reflex syncope== | ==Reflex syncope== | ||