Did This Patient Have Cardiac Syncope?: The Rational Clinical Examination Systematic Review.

@article{Albassam2019DidTP,
  title={Did This Patient Have Cardiac Syncope?: The Rational Clinical Examination Systematic Review.},
  author={Omar Albassam and Robert J Redelmeier and Steven Shadowitz and Aatif M. Husain and David L. Simel and Edward E. Etchells},
  journal={JAMA},
  year={2019},
  volume={321 24},
  pages={
          2448-2457
        }
}
Importance Syncope can result from a reduction in cardiac output from serious cardiac conditions, such as arrhythmias or structural heart disease (cardiac syncope), or other causes, such as vasovagal syncope or orthostatic hypotension. Objective To perform a systematic review of studies of the accuracy of the clinical examination for identifying patients with cardiac syncope. Study Selection Studies of adults presenting to primary care, emergency departments, or referred to specialty… 
Age is the most important clinical feature to help rule out cardiac syncope
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It is shown that age greater than 35 has the highest sensitivity for cardiac causes in patients with syncope, and the American College of Cardiology and American Heart Association have outlined an approach to evaluate syncopal patients in their 2017 guideline.
ACR Appropriateness Criteria® Syncope.
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The mainstay of syncope and presyncope assessment is a detailed history and physical examination, but imaging can play a role in certain situations and resting transthoracic echocardiography is usually considered appropriate for the initial imaging.
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TLDR
This study identified important unmet needs regarding the optimal management of syncope and variable syncope guideline implementation among European physicians.
Use of the Clinical Examination in the Diagnosis of Cardiac Syncope.
TLDR
It is important emergency providers differentiate cardiac syncope from other causes, as it is associated with an increased risk of premature death and cardiac events.
Cardiogenic vertigo: characteristics and proposed diagnostic criteria
TLDR
Characteristics of CV, set age, duration of vertigo, accompanying symptoms, and underlying cardiac diseases can aid in differentiation from other vestibular disorders and reduce morbidity and mortality associated with cardiac syncope are defined.
Sex Differences in Patients Hospitalized for Syncope: Experience in University Hospital of Middle-income Country and with a Predominance of Chagasic Etiology
TLDR
Men hospitalized for syncope were older, had more systolic ventricular dysfunction, and had higher Martin and OESIL scores, and the main causes of syncopes were ventricular tachycardia and bradyarrhythmias among men and supraventricularTachycardias among women.
Syncope in the Emergency Department: A Guide for Clinicians.
TLDR
By incorporating risk stratification and shared decision-making into syncope care, practitioners can more confidently engage patients and families in disposition decisions to organize appropriate outpatient and follow-up care, observation, or admission.
Syncope as the Initial Manifestation of Advanced Nasopharyngeal Carcinoma: A Case Report
  • Si-Cheng Zhang, Maoning Lin, +4 authors Yan-Song Guo
  • Frontiers in Cardiovascular Medicine
  • 2021
Carotid sinus syndrome is a principal cause of syncope in the elderly. Syncope, associated with carotid sinus syndrome which is secondary to metastasis of advanced nasopharyngeal carcinoma, rarely
Multivariable risk scores for predicting short‐term outcomes for emergency department patients with unexplained syncope: A systematic review
TLDR
The objective was to systematically review the accuracy of multivariate risk stratification scores for identifying adult syncope patients at high and low risk of an adverse event over the next 30 days.
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TLDR
A critical analysis of the pros and cons of the commonly considered outcomes insyncope studies is presented, and possible solutions to improve their choice in ED syncope studies are provided.
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A simple score derived from clinical history can be usefully employed for the triage and management of patients with syncope in an ED.
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BACKGROUND Little is known about the epidemiology and prognosis of syncope in the general population. METHODS We evaluated the incidence, specific causes, and prognosis of syncope among women and
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TLDR
Cardiac troponin T levels show a limited diagnostic and predictive accuracy for the identification of patients with syncope at high risk, and increased cTnThs levels indicate adverse prognosis in patients with noncardiac causes of syncope, but not in patientsWith cardiac syncope being a risk factor for adverse outcome by itself.
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TLDR
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TLDR
Compared with younger patients, the medical history has a limited value in the diagnosis of the cause of syncope in older patients, and the specificity of some features is high but these can be observed in only a minority of patients.
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TLDR
NT-pro-BNP assessment was helpful in differentiating cardiac from non-cardiac syncope and patients requiring interventional cardiological therapy with a sensitivity and specificity of 90% and 93.8%, respectively.
Validation of EGSYS Score in Prediction of Cardiogenic Syncope
TLDR
The results of this study demonstrated the acceptable accuracy of EGSYS score in predicting cardiogenic causes of syncope at the ≥3 cut-off point and it seems that using this model in daily practice can help physicians select at risk patients and properly triage them.
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TLDR
In patients hospitalized for syncope, NT-pro-BNP was a strong and independent diagnostic and prognostic marker and addition to conventional criteria of history and examination improved the discriminatory performance.
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TLDR
Reflex syncope remains the most common cause of syncope, but all-cause mortality in subjects with reflex syncope is not higher than in the general population, and in emergency departments, cardiac causes and orthostatic hypotension are more frequent especially in elderly subjects.
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