Orthostatic blood pressure measurements are often overlooked during the initial evaluation of syncope in the emergency department

Blood Pressure Monitoring
Micah L A HeldewegMark P M Harms

Abstract

The renewed 2018 syncope guidelines published by the European Society of Cardiology (ESC) reiterate that the initial evaluation of syncope should include history taking, physical examination, an electrocardiogram, and orthostatic blood pressure measurements (OBPM). However, the importance of evaluating for orthostatic hypotension (OH) often remains underappreciated in clinical practice. In this study, we examine the initial evaluation of syncope on an ED. We retrospectively reviewed 2 years of consecutive medical records of patients presenting with a syncope to the ED of a university hospital. We collected patient demographics and data on initial syncope evaluation for further analysis. In a cohort of 289 patients, OBPM and ECG were performed in 16 and 89% of the cases, respectively. An OBPM was performed in only 52% of the patients who received a working diagnosis of OH. In the other 48%, the OH diagnosis was likely made on the basis of history taking and exclusion of other syncope causes. OBPM are infrequently used during the initial evaluation of syncope irrespective of its consistent inclusion in ESC syncope guidelines. The discordance between clinical practice and the ESC syncope guidelines calls for increased awareness of...Continue Reading

References

Oct 2, 2007·The American Journal of Medicine·Vishal Gupta, Lewis A Lipsitz
Nov 29, 2008·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Frances McCarthyUNKNOWN European Society of Cardiology
Aug 29, 2009·European Heart Journal·UNKNOWN Task Force for the Diagnosis and Management of SyncopeWouter Wieling
Mar 11, 2010·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Gonzalo Baron-EsquiviasPedro Laguna
Nov 22, 2011·Journal of the American Society of Hypertension : JASH·Carlos Feldstein, Alan B Weder
Mar 12, 2013·Progress in Cardiovascular Diseases·Rose Anne KennyBellinda L King-Kallimanis

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Citations

Feb 2, 2019·BMJ : British Medical Journal·Terence J QuinnJennifer K Burton
Aug 5, 2020·Journal of Cardiovascular Translational Research·Anzhela SolovevaMarat Fudim
May 1, 2020·European Heart Journal. Case Reports·Muhammad Hamza Saad ShaukatRadmila Lyubarova
May 8, 2021·Current Hypertension Reports·Vasiliki KatsiKonstantinos Tsioufis

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