Syncope Follow-up

  • Author: Rumm Morag, MD, FACEP; Chief Editor: David FM Brown, MD   more...
 
Updated: Aug 11, 2011
 

Further Inpatient Care

The Syncope Evaluation in the Emergency Department Study (SEEDS) data suggest that specialized syncope units with protocoled approaches to ruling out cardiac causes of syncope reduce hospital costs and length of stay without compromising quality of care.[25]

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Transfer

  • Patients with select etiologies of syncope may require transfer for specialty evaluation or procedures.
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Deterrence/Prevention

Education may have a substantial impact on the prevention of recurrence, especially in situational and orthostatic syncope.

Patients may be trained to avoid situations that prompt syncope in situational cases.

In orthostatic syncope, patients should drink 500 mL of fluid each morning in addition to their usual routine and should avoid standing up too quickly.

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Complications

Patients with recurrent syncope should be cautioned to avoid tall ledges and to refrain from driving.

Recurrent falls due to syncope can result in lacerations, orthopedic injuries, and intracranial trauma.

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Prognosis

Cardiac syncope has a poorer prognosis than other forms of syncope. The 1-year end point mortality rate has been shown to be as high as 18-33%. Studies evaluating mortality rates within 4 weeks of presentation and 1 year after presentation both report statistically significant increases in this patient group. Patients with cardiac syncope may be significantly restricted in their daily activities, and the occurrence of syncope may be a symptom of their underlying disease progression.

Syncope of any etiology in a patient with cardiac conditions (to be differentiated from cardiac syncope) has also been shown to imply a poor prognosis. Patients with NYHA functional class III or IV who have any type of syncope have a mortality rate as high as 25% within 1 year.

However, some patients do well after definitive surgical treatment or pacemaker placement.

Noncardiac syncope seems to have no effect on overall mortality rates and includes syncope due to vasovagal response, autonomic insufficiency, situations, and orthostatic positions.

Vasovagal syncope has a uniformly excellent prognosis. This condition does not increase the mortality rate, and recurrences are infrequent.

Situational syncope and orthostatic syncope also have an excellent prognosis. They do not increase the risk of death; however, recurrences do occur and are sometimes a source of significant morbidity in terms of quality of life and secondary injury.

Syncope of unknown etiology generally has a favorable prognosis, with 1-year follow-up data showing a low incidence of sudden death (2%), a 20% chance of recurrent syncope, and a 78% remission rate.

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Patient Education

Patients who present to the ED with syncope should be instructed not to drive. Syncope-related injury during driving is rare but has been documented.

For excellent patient education resources, visit eMedicine's Brain and Nervous System. Also, see eMedicine's patient education article Fainting.

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Contributor Information and Disclosures
Author

Rumm Morag, MD, FACEP  Member of Salem Emergency Physician Services, PC (SEPS), Salem Hospital

Rumm Morag, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Barry E Brenner, MD, PhD, FACEP  Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David A Peak, MD  Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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