Cardiology clinics
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A syncope evaluation should start by identifying potentially life-threatening causes, including valvular heart disease, cardiomyopathies, and arrhythmias. Most patients who present with syncope, however, have the more benign vasovagal (reflex) syncope. ⋯ Recognition of these potential confounders of syncope might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. This article reviews the presentation of the vasovagal syncope confounder and the putative pathophysiology of orthostatic hypotension, and suggests options for nonpharmacologic and pharmacologic management.
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The overall risk for a patient entering the emergency department (ED) because of syncope ranges between 5% and 15%, and the mortality at 1 week is approximately 1%. The primary goal for the ED physician is thus to discriminate individuals at low risk, who can be safely discharged, from patients at high risk, who warrant a prompt hospitalization for monitoring and/or appropriate treatment. Different rules and risk scores have been proposed. More ad hoc studies are needed to define the prognostic and diagnostic roles of the brain natriuretic peptide and other noninvasive laboratory markers.
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Clinical decision making can be challenging regarding the emergency department (ED) management of patients with recent syncope. Several models of the syncope management unit are summarized in this article. Assessment of patients with recent syncope in a specialized evaluation unit, such as an emergency department-based syncope management unit, holds great promise in terms of reducing hospital admissions, reducing costs and improving outcomes for patients with syncope.