CLINICAL STUDY: ELECTROPHYSIOLOGY
Diagnostic value of history in patients with syncope with or without heart disease
Paolo Alboni, MD, FACC*,
Michele Brignole, MD ,
Carlo Menozzi, MD ,
Antonio Raviele, MD ,
Attilio Del Rosso, MD||,
Maurizio Dinelli, MD*,
Alberto Solano, MD and
Nicola Bottoni, MD
* Division of Cardiology, Ospedale Civile, Cento, Italy
Section of Arrhythmology, Department of Cardiology, Ospedali Riuniti, Lavagna, Italy
Section of Arrhythmology, Department of Cardiology, Ospedale S. Maria Nuova, Reggio Emilia, Italy
Division of Cardiology, Ospedale Umberto I, Mestre, Italy
|| Division of Cardiology, Ospedale S. Pietro Igneo, Fucecchio, Italy
Manuscript received September 19, 2000;
revised manuscript received January 24, 2001,
accepted February 12, 2001.
Reprint requests and correspondence: Dr. Paolo Alboni, Division of Cardiology, Ospedale Civile, 44042 Cento (Fe), Italy
p.alboni{at}ausl.fe.it
OBJECTIVES
We sought to establish what historical findings are predictive of the cause of syncope.
BACKGROUND
The clinical features of the various types of syncope have not been systematically investigated.
METHODS
Three hundred forty-one patients with syncope were prospectively evaluated. Each patient was interviewed using a standard questionnaire. A cause of syncope was assigned using standardized diagnostic criteria.
RESULTS
A cardiac cause of syncope was established in 23% of the patients, a neurally mediated cause in 58% and a neurologic or psychiatric cause in 1%, and in the remaining 18%, the cause of syncope remained unexplained. In a preliminary analysis including age, gender and the presence of suspected or certain heart disease after the initial evaluation, only heart disease was an independent predictor of a cardiac cause of syncope (odds ratio 16, p = 0.00001), with a sensitivity of 95% and a specificity of 45%. In contrast, the absence of heart disease allowed us to exclude a cardiac cause of syncope in 97% of the patients. In patients with certain or suspected heart disease, the most specific predictors of a cardiac cause were syncope in the supine position or during effort, blurred vision and convulsive syncope. Significant and specific predictors of a neurally mediated cause were time between the first and last syncopal episode >4 years, abdominal discomfort before the loss of consciousness and nausea and diaphoresis during the recovery phase. In the patients without heart disease, palpitation was the only significant predictor of a cardiac cause.
CONCLUSIONS
The presence of suspected or certain heart disease after the initial evaluation is a strong predictor of a cardiac cause of syncope. A few historical findings are useful to predict cardiac and neurally mediated syncope in patients with and without heart disease.
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Abbreviations and Acronyms
| | ATP | = adenosine triphosphate | | AV | = atrioventricular | | ECG | = electrocardiogram or electrocardiographic |
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