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Differential diagnosis
Echocardiography was useful in evaluating unexplained syncope

https://doi.org/10.1136/ebm.8.3.96

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    (2002) Heart 88, 36. Sarasin FP, Junod AF, Carballo D, et al.. Role of echocardiography in the evaluation of syncope: a prospective study.. ;. :. –37..
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 QUESTION: What role does echocardiography have in determining the causes of unexplained syncope?

    Design

    18 month cohort study.

    Setting

    Emergency department (ED) and inpatient services of a university hospital in Geneva, Switzerland.

    Patients

    650 consecutive patients who were ≥18 years of age (mean age 60 y, 54% women) and presented to the ED with the main symptom of syncope (sudden loss of consciousness and of postural tone with spontaneous recovery). Follow up was 95% at 18 months.

    Diagnostic strategy

    The initial diagnostic workup included a standardised clinical evaluation; baseline laboratory tests; 12 lead electrocardiography (ECG); and testing for orthostatic hypotension. Selected additional testing was done based on abnormal findings after the initial workup. Patients in whom the cause of syncope remained undetermined received serial cardiovascular diagnostic tests: bidimensional Doppler transthoracic echocardiography, bilateral carotid sinus massage, prolonged monitoring with ECG, and passive upright tilt testing. Electrophysiological studies …

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    Footnotes

    • Source of funding: Swiss National Research Foundation.

    • For correspondence: Dr F P Sarasin, Hôpital Cantonal, Geneva, Switzerland.francois.sarasin{at}hcuge.ch

    • Abstract and commentary also appear in ACP Journal Club.