Diagnosis of Syncope

Diagnosis of Syncope

What are the diagnostic tests used for syncope?

There are several types of tests used to confirm cardiac causes in presenting syncope. These tests have varying degrees of specificity and accuracy, but are commonly used in the diagnosis of cardiac syncope:

• Family history and physical exam
• ECG
• Holter monitoring
• External loop recorder
• Tilt Table Testing
• Electrophysiology study
• Neurological studies (CT/MRI)
• Implantable loop recorder (ILR)

Patient History

Patient history has been shown to be an important tool to use in identifying the specific type of syncope. Frequency of syncopal events is often an important detail to include in the patient history as many patients with syncope have symptoms/events that occur infrequently.

Important considerations also include:

Pre-syncope

• Position before syncopal episode (i.e standing for a prolonged period of time)
• What activity was occurring prior to the event?
• Sudden change in position
• Supine
• Method of fall- protected / unprotected / slumping over
• Rotational episodes / Vertigo
  

Post-syncope

• Amnesiac event post syncope
• Eyes open / closed (if witnessed)
• Nausea / vomiting episode
• Incontinence
• Sustained neurological episode
• Seizure like activity
• Length of the syncopal episode in time (short / long)
• Tongue biting / bleeding from the mouth
• Slow pulse / difficult to feel
• Disorientation, that is transient in nature¹.
  

Patient history is a key tool for identifying the cause of syncope and should include questions including:

• Was there anyone who witnessed the syncopal event?
• Family history such as sudden cardiac death / arrhythmia?
• Did the patient experience any palpitations?
• What medications does the patient take?
• Recent change / addition of medications?
• Frequency of events?
• Any previous cardiac disease?
• Any previous medical / endocrine disease?

Patient Examination

A thorough patient examination is a key step in uncovering the potential cause of syncope. This clinical examination should include (but not be limited to):

12 lead ECG

• Identifying abnormalities such as bradycardia/ heart block, channelopathies such as Brugada syndrome, long QT syndrome

Echocardiogram

• Identifying left ventricular ejection fraction
• Identifying any structural heart abnormality

Thorough cardiovascular assessment:

• Auscultation of heart listening for murmurs
• Evidence of heart failure (raised JVP etc)
• Postural blood pressure (lying and standing)
• Addition or omission of medication

Blood tests/review

• Aimed at identifying anaemia/ endocrine disorders/ troponin/ BNP levels

Detailed Neurological examination

• Identifying sensory deficits
• Confusion
• Limb weakness

Learn more about the syncope treatment options for Australians.

Patient Disclaimer: All content on the Hope For Hearts site is created and published online for general information purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Please see your doctor if you have any questions or concerns.