Indications for electrophysiology include patients with coronary artery disease and syncope, coronary artery disease with an ejection fraction less than 35 percent, and possibly nonischemic dilated cardiomyopathy. Laboratory testing in the evaluation of syncope should be ordered as clinically indicated by the history and physical examination. Patients with syncope and evidence of heart failure or structural heart disease should be admitted to the hospital for monitoring and evaluation.Īll patients presenting with syncope should have orthostatic vital signs and standard 12-lead electrocardiography. Although a subset of patients will have unexplained syncope despite undergoing a comprehensive evaluation, those with multiple episodes compared with an isolated event are more likely to have a serious underlying disorder. In cases of unexplained syncope, further testing such as echocardiography, grade exercise testing, electrocardiographic monitoring, and electrophysiologic studies may be required. Patients with neurally mediated or orthostatic syncope usually require no additional testing. Patients with cardiovascular disease, abnormal electrocardiography, or family history of sudden death, and those presenting with unexplained syncope should be hospitalized for further diagnostic evaluation. All patients presenting with syncope require electrocardiography, orthostatic vital signs, and QT interval monitoring. Guidelines suggest an algorithmic approach to the evaluation of syncope that begins with the history and physical examination. Useful clinical rules to assess the short-term risk of death and the need for immediate hospitalization include the San Francisco Syncope Rule and the Risk Stratification of Syncope in the Emergency Department rule. Patients presenting with syncope (other than neurally mediated and orthostatic syncope) are at increased risk of death from any cause.

Common nonsyncopal syndromes with similar presentations include seizures, metabolic and psychogenic disorders, and acute intoxication. Older adults are more likely to have orthostatic, carotid sinus hypersensitivity, or cardiac syncope, whereas younger adults are more likely to have vasovagal syncope. It is classified as neurally mediated (i.e., carotid sinus hypersensitivity, situational, or vasovagal), cardiac, orthostatic, or neurogenic. Syncope is a transient and abrupt loss of consciousness with complete return to preexisting neurologic function.

Syncopal episode icd 9