Review
Important points in the clinical evaluation of patients with syncope
W Arthur, G C KayeCastle Hill
Hospital, Castle Road, East Yorkshire, UK
Correspondence to: Dr Wayne Arthur, Department of Cardiology, Peterborough District Hospital, Thorpe Road, Peterborough PE3 5DE, UK wayne@denecres.freeserve.co.uk
Submitted 30 December
1999;
Accepted 16 February 2000
| The first 150 words of the full text of this article appear below. |
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Introduction |
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A careful history, physical examination, and an electrocardiogram (ECG) are the most important components of the evaluation of a syncopal episode. These three components will provide a diagnosis or determine whether diagnostic testing is necessary in most patients.1 The potential cost savings made by avoiding unnecessary and expensive investigations are obvious when one considers that good clinical skills lead to the identification of the cause of syncope in 75%-85% of cases in which a successful diagnosis is made.2
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History |
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A comprehensive account of the events preceding the syncopal spell
is invaluable for diagnosis (box 1). The premonitory (prodromal) symptoms, precipitating factors, rate of onset, witnessed accounts, features during the recovery phase, past medical history, and the
frequency and previous history of syncope will assist in the diagnosis
and direct the physician in the evaluation of patients. The
differential diagnosis for syncope varies with age; this fact coupled
with other historical findings
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