Value and limitations of noninvasive assessment of syncope
Abstract
The noninvasive assessment of patients who present with syncope is based on a thorough, complete history and physical examination. The history requires close attention to precipitating events and the description of the spell. Often, patients are poor historians with regard to symptoms leading up to and following the episode of syncope. Therefore, it is important to interview individuals who observed the spell to improve the accuracy of the history and sort out whether or not the spell was due to cardiogenic syncope, vasodepressor syncope, or a neurologic disorder. Carotid sinus massage is a useful procedure that can be performed during the routine physical examination, identifying patients who are at increased risk for carotid sinus syncope because of hypersensitivity of the carotid sinus. The clinician must be careful to attribute the clinical syncope to carotid sinus hypersensitivity only when the spell induced at the time of carotid massage reproduces the clinical spell. Routine laboratory tests are commonly performed, although the blood tests rarely yield information to confirm the cause of syncope. The routine ECG is often helpful identifying abnormalities of rhythm, conduction, or morphology that give a clue as to the cau...Continue Reading
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