Syncope—Are We Missing an Important Cause?

By Adam Schaffer, MD
April 19, 2017

As a hospitalist, syncope is an admitting diagnosis that I consider a challenge. Syncope is a presentation that we see frequently, and so can start to seem routine. Though published estimates of the causes of syncope vary, most have shown that the etiologies of syncope that we are most concerned about—such as bradyarrhythmias or ventricular tachyarrhythmias—make up a minority of cases. In one retrospective cohort study of the causes of syncope in 987 patients who were referred for cardiac electrophysiology evaluation, bradyarrhythmias accounted for 13.6% of cases and ventricular tachyarrhythmias accounted for 12.1% of cases.1  Vasovagal syncope, among the more benign etiologies of syncope, accounted for 47.0% of cases. These numbers come from a population of patients who were referred for electrophysiology evaluation, and so it is very possible that cardiac arrhythmias were overrepresented in this population compared to an unselected group of patients. Thus clinicians who evaluate syncope patients need to remain vigilant in order to correctly identify the minority of syncope patients who have a potentially serious cause of their syncopal episode. Continue reading “Syncope—Are We Missing an Important Cause?”