FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 343:1856-1862 December 21, 2000 Number 25 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous. The pathophysiology of all forms of syncope consists of a sudden decrease in or brief cessation of cerebral blood flow. Syncope is common, disabling, and possibly associated with a risk of sudden death, but its causes are difficult to diagnose.^1,2,3 Consequently, syncope often leads to hospital admission, multiple consultations, and the performance of many diagnostic tests.⁴ This article provides an approach to the evaluation of syncope.

Is It Syncope?

The first important issue is distinguishing syncope from several other symptoms. Dizziness, presyncope, . . . [Full Text of this Article]

Differential Diagnosis

The Importance of Heart Disease

Diagnosing the Cause of Syncope

Initial Assessment Leading to a Diagnosis

Initial Assessment Suggesting a Diagnosis

Unexplained Syncope

            Patients with Structural Heart Disease or Electrocardiographic Abnormalities

            Patients with Normal Findings on Electrocardiography and No Heart Disease

            Reassessment

Diagnostic Tests

Initial Assessment and Base-Line Laboratory Tests

Evaluation for Underlying Heart Disease

Testing for Arrhythmias

            Ambulatory Monitoring

            Continuous-Loop Event Monitoring

Electrophysiologic Studies

Evaluation for Neurally Mediated Syncope

Neurologic Testing

Psychiatric Evaluation

Hospitalization

Treatment

Source Information

From the University of Pittsburgh School of Medicine, Pittsburgh.

References

This article has been cited by other articles:

• Sorajja, D., Nesbitt, G. C., Hodge, D. O., Low, P. A., Hammill, S. C., Gersh, B. J., Shen, W.-K. (2009). Syncope While Driving: Clinical Characteristics, Causes, and Prognosis. Circulation 120: 928-934 [Abstract] [Full Text]  
• Thomas, K. N., Cotter, J. D., Galvin, S. D., Williams, M. J. A., Willie, C. K., Ainslie, P. N. (2009). Initial orthostatic hypotension is unrelated to orthostatic tolerance in healthy young subjects. J. Appl. Physiol. 107: 506-517 [Abstract] [Full Text]  
• Mussi, C., Ungar, A., Salvioli, G., Menozzi, C., Bartoletti, A., Giada, F., Lagi, A., Ponassi, I., Re, G., Furlan, R., Maggi, R., Brignole, M., for the Evaluation of Guidelines in Syncope Study, (2009). Orthostatic Hypotension As Cause of Syncope in Patients Older Than 65 Years Admitted to Emergency Departments for Transient Loss of Consciousness. J Gerontol A Biol Sci Med Sci 64A: 801-806 [Abstract] [Full Text]  
• Gill, S. S., Anderson, G. M., Fischer, H. D., Bell, C. M., Li, P., Normand, S.-L. T., Rochon, P. A. (2009). Syncope and Its Consequences in Patients With Dementia Receiving Cholinesterase Inhibitors: A Population-Based Cohort Study. Arch Intern Med 169: 867-873 [Abstract] [Full Text]  
• Spirito, P., Autore, C., Rapezzi, C., Bernabo, P., Badagliacca, R., Maron, M. S., Bongioanni, S., Coccolo, F., Estes, N.A. M., Barilla, C. S., Biagini, E., Quarta, G., Conte, M. R., Bruzzi, P., Maron, B. J. (2009). Syncope and Risk of Sudden Death in Hypertrophic Cardiomyopathy. Circulation 119: 1703-1710 [Abstract] [Full Text]  
• Olde Nordkamp, L. R.A., Wieling, W., Zwinderman, A. H., Wilde, A. A.M., van Dijk, N. (2009). Genetic aspects of vasovagal syncope: a systematic review of current evidence. Europace 11: 414-420 [Abstract] [Full Text]  
• Iniesta, I., Yotti, R., Garcia-Pastor, A. (2009). Transient loss of consciousness with convulsions in two young adults with potentially fatal underlying heart disease: syncope versus seizures. BMJ Case Reports 2009: bcr0620080285-bcr0620080285 [Abstract] [Full Text]  
• Karakis, I., Petrea, R. E., Wiesman, J. F., Jalisi, S. (2008). Clinical Reasoning: A 51-year-old woman with syncopal episodes and multiple cranial neuropathies. Neurology 71: e18-e23 [Full Text]  
• Kuhne, M., Schaer, B., Moulay, N., Sticherling, C., Osswald, S. (2007). Holter monitoring for syncope: diagnostic yield in different patient groups and impact on device implantation. QJM 100: 771-777 [Abstract] [Full Text]  
• Benezet-Mazuecos, J., Ibanez, B., Rubio, J. M., Navarro, F., Martin, E., Romero, J., Farre, J. (2007). Utility of in-hospital cardiac remote telemetry in patients with unexplained syncope. Europace 9: 1196-1201 [Abstract] [Full Text]  
• Deacon, B. (2007). Two-Day, Intensive Cognitive-Behavioral Therapy for Panic Disorder: A Case Study. Behav Modif 31: 595-615 [Abstract]  
• Strickberger, S. A., Benson, D. W., Biaggioni, I., Callans, D. J., Cohen, M. I., Ellenbogen, K. A., Epstein, A. E., Friedman, P., Goldberger, J., Heidenreich, P. A., Klein, G. J., Knight, B. P., Morillo, C. A., Myerburg, R. J., Sila, C. A. (2006). AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation In Collaboration With the Heart Rhythm Society. J Am Coll Cardiol 47: 473-484 [Full Text]  
• Strickberger, S. A., Benson, D. W., Biaggioni, I., Callans, D. J., Cohen, M. I., Ellenbogen, K. A., Epstein, A. E., Friedman, P., Goldberger, J., Heidenreich, P. A., Klein, G. J., Knight, B. P., Morillo, C. A., Myerburg, R. J., Sila, C. A. (2006). AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: In Collaboration With the Heart Rhythm Society: Endorsed by the American Autonomic Society. Circulation 113: 316-327 [Full Text]  
• Strano, S, Colosimo, C, Sparagna, A, Mazzei, A, Fattouch, J, Giallonardo, A T, Calcagnini, G, Bagnato, F (2005). Multidisciplinary approach for diagnosing syncope: a retrospective study on 521 outpatients. J. Neurol. Neurosurg. Psychiatry 76: 1597-1600 [Abstract] [Full Text]  
• Grossman, S. A., Shapiro, N. I., Van Epp, S., Kohen, R., Arnold, R., Moore, R., Lee, L., Wolfe, R. E., Lipsitz, L. A. (2005). Sex Differences in the Emergency Department Evaluation of Elderly Patients With Syncope. J Gerontol A Biol Sci Med Sci 60: 1202-1205 [Abstract] [Full Text]  
• Binder, W. D., Fifer, M. A., King, M. E., Stone, J. R. (2005). Case 26-2005 - A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging. NEJM 353: 824-832 [Full Text]  
• Drew, B. J., Califf, R. M., Funk, M., Kaufman, E. S., Krucoff, M. W., Laks, M. M., Macfarlane, P. W., Sommargren, C., Swiryn, S., Van Hare, G. F. (2004). Practice Standards for Electrocardiographic Monitoring in Hospital Settings: An American Heart Association Scientific Statement From the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: Endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation 110: 2721-2746 [Abstract] [Full Text]  
• Chen-Scarabelli, C., Scarabelli, T. M (2004). Neurocardiogenic syncope. BMJ 329: 336-341 [Full Text]  
• Ahmad, S, Beckett, M W (2004). Value of serum prolactin in the management of syncope. Emerg. Med. J. 21: e3-3 [Abstract] [Full Text]  
• Lu, C.-C., Diedrich, A., Tung, C.-S., Paranjape, S. Y., Harris, P. A., Byrne, D. W., Jordan, J., Robertson, D. (2003). Water Ingestion as Prophylaxis Against Syncope. Circulation 108: 2660-2665 [Abstract] [Full Text]  
• Grossman, S. A., Van Epp, S., Arnold, R., Moore, R., Lee, L., Shapiro, N. I., Wolfe, R. E., Lipsitz, L. A. (2003). The Value of Cardiac Enzymes in Elderly Patients Presenting to the Emergency Department With Syncope. J Gerontol A Biol Sci Med Sci 58: M1055-M1058 [Abstract] [Full Text]  
• Kurer, C. C. (2003). Implantable looprecorders: dollars and sense. J Am Coll Cardiol 42: 502-504 [Full Text]  
• Colivicchi, F., Ammirati, F., Melina, D., Guido, V., Imperoli, G., Santini, M., for the OESIL study investigators, (2003). Development and prospective validation of a risk stratification system for patients with syncope in the emergency department: the OESIL risk score. Eur Heart J 24: 811-819 [Abstract] [Full Text]  
• David, J. E., Yale, S. H., Vidaillet, H. J. (2003). Hyperventilation-Induced Syncope: No Need to Panic. Clin Med Res 1: 137-139 [Abstract] [Full Text]  
• Van Lieshout, J. J., Wieling, W., Karemaker, J. M., Secher, N. H. (2003). Syncope, cerebral perfusion, and oxygenation. J. Appl. Physiol. 94: 833-848 [Abstract] [Full Text]  
• Schroeder, C., Bush, V. E., Norcliffe, L. J., Luft, F. C., Tank, J., Jordan, J., Hainsworth, R. (2002). Water Drinking Acutely Improves Orthostatic Tolerance in Healthy Subjects. Circulation 106: 2806-2811 [Abstract] [Full Text]  
• Autore, C., Conte, M. R., Piccininno, M., Bernabo, P., Bonfiglio, G., Bruzzi, P., Spirito, P. (2002). Risk associated with pregnancy in hypertrophic cardiomyopathy. J Am Coll Cardiol 40: 1864-1869 [Abstract] [Full Text]  
• Sarasin, F P, Junod, A-F, Carballo, D, Slama, S, Unger, P-F, Louis-Simonet, M (2002). Role of echocardiography in the evaluation of syncope: a prospective study. Heart 88: 363-367 [Abstract] [Full Text]  
• Krediet, C.T. P., van Dijk, N., Linzer, M., van Lieshout, J. J., Wieling, W. (2002). Management of Vasovagal Syncope: Controlling or Aborting Faints by Leg Crossing and Muscle Tensing. Circulation 106: 1684-1689 [Abstract] [Full Text]  
• Maisel, W. H., Stevenson, W. G. (2002). Syncope -- Getting to the Heart of the Matter. NEJM 347: 931-933 [Full Text]  
• Santini, M., Colivicchi, F. (2002). In-hospital management of syncope: the European perspective. Eur Heart J 23: 767-768 [Full Text]  
• Protonotarios, N., Tsatsopoulou, A., Anastasakis, A., Sevdalis, E., McKoy, G., Stratos, K., Gatzoulis, K., Tentolouris, K., Spiliopoulou, C., Panagiotakos, D., McKenna, W., Toutouzas, P. (2001). Genotype-phenotype assessment in autosomal recessive arrhythmogenic right ventricular cardiomyopathy (Naxos disease) caused by a deletion in plakoglobin. J Am Coll Cardiol 38: 1477-1484 [Abstract] [Full Text]  
• Olshansky, B. (2001). Syncope Evaluation at a Crossroad : For Which Patients?. Circulation 104: 7-8 [Full Text]  
• Verdino, R. J., Marchlinski, F. E., Fernandez-Fernandez, F. J., Sesma, P., Kapoor, W. N. (2001). Syncope. NEJM 344: 1098-1099 [Full Text]  
• (2001). Diagnosis and Management of Syncope. JWatch Neurology 2001: 7-7 [Full Text]