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QUESTION: What role does echocardiography have in determining the causes of unexplained syncope?
18 month cohort study.
Emergency department (ED) and inpatient services of a university hospital in Geneva, Switzerland.
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.
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 …