Infrequent Unexplained Fainting (Syncope)
Syncope can be caused by any number of conditions, including metabolic disorders, neurological conditions, exhaustion, dehydration, emotional distress or cardiovascular conditions. However, for approximately one third of all people who faint. a cause cannot be identified with standard testing1. Unexplained syncope may lead to negative personal consequences such as suspension of driving privileges or limited employment opportunities.
Syncope caused by a cardiac condition can be especially challenging to diagnose because abnormal heart activity may be infrequent or not apparent to the patient. Syncope with a cardiac cause can lead to sudden cardiac death.
Examples of conditions causing cardiac syncope include:
- Prior myocardial infarction
- Arrhythmia (Bradycardia, Tachycardia)
- Obstructed blood flow
- Congestive heart failure
- Hypotension
Who is at risk?
The risk of cardiovascular syncope increases with age, and is becoming more common as the population ages. Monitoring is advised for patients with syncope, near syncope, dizziness or recurrent unexplained palpitations. Special attention should be paid to patients involved in ‘high risk’ activity (over-the-road drivers, pilots, machine operators, etc.).
Statistics
In the United States, syncope accounts for 3-5% of emergency room visits and 1-6% of urgent hospital admissions2 at an annual cost of approximately $2.4 billion3.
Diagnosis options
A thorough history, physical examination and electrocardiography can yield an initial diagnosis in a number of cases. Patients who require additional testing pose a greater challenge. Difficult-to-diagnose patients at risk for arrhythmias should be monitored. Thorough, accurate data of cardiac activity can assist you in prescribing optimal pharmaceutical therapy or implantable therapeutic devices.
1. Kapoor WN. Syncope. The New England Journal of Medicine. December 21, 2000;343:1856-1862. Review Article.
2. Shen WK, Decker WW, Smars PA, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): A Multidisciplinary Approach to Syncope Management. Circulation. 2004;110:3636-3645.
3. Sun BC, Emond JA, Camargo CA. Direct medical costs of syncope-related hospitalizations in the United States. The Am J of Cardiology. 2005;95:668-71.
