Summary
Definition
History and exam
Other diagnostic factors
- history of recurrent faints
- absence of structural heart disease
- provocative factor
- nausea
- lightheadedness
- pallor
- diaphoresis
- diminished vision or hearing
- physical injury
- fatigue after episode
- palpitations
- bradycardia
- absence of family history of sudden death
- neuralgia
Risk factors
- prior syncope
- prior history of arrhythmias, myocardial infarction, heart failure, or cardiomyopathy
- severe aortic stenosis
- prolonged standing
- emotional stress (especially in a warm, crowded environment)
- dehydration/hypovolemia
- preceding episode of nausea and/or vomiting
- preceding episode of severe pain
Diagnostic tests
1st tests to order
- 12-lead ECG
- serum hemoglobin
- plasma blood glucose
- serum beta-hCG (human chorionic gonadotropin)
- cardiac enzymes
- D-dimer level
- serum cortisol
- BUN and serum creatinine
Tests to consider
- echocardiogram
- tilt-table test
- carotid sinus massage (CSM)
- insertable loop recorder
- electrophysiologic study
- Valsalva maneuver
- active standing test
- cold pressor test
- cough test
Emerging tests
- adenosine triphosphate (ATP) test
Treatment algorithm
vasovagal faint
situational faint
carotid sinus syndrome
Contributors
Authors
Bryant Lin, MD
Clinical Assistant Professor of Medicine
Division of Primary Care and Population Health
Stanford University School of Medicine
Stanford
CA
Disclosures
BL declares that he has no competing interests.
Paul J. Wang, MD, FACC, FHRS
Professor of Medicine
Stanford Arrhythmia Service
Stanford University School of Medicine
Stanford
CA
Disclosures
PJW receives fellowship support, honoraria, and clinical trial support from Medtronic, which manufactures LINQ, an implantable loop recorder.
Acknowledgements
Dr Bryant Lin and Dr Paul J. Wang would like to gratefully acknowledge Dr David G. Benditt and Dr John T. Nguyen, previous contributors to this topic.
Disclosures
DGB has consultant and equity positions: Medtronic Inc., St Jude Medical Inc., Transoma Inc., Cardionet Inc. DGB is also an author of several references cited in this topic. JTN declares that he has no competing interests.
Peer reviewers
Sanjiv Petkar, MBBS, MD, DM (Cardiology), MRCP
Consultant Cardiologist
Hull and East Riding of Yorkshire NHS Trust
Castle Hill Hospital
East Yorkshire
UK
Disclosures
SP has received sponsorship in the past from Medtronic, Inc. and St Jude Medical, Inc. for attending conferences. He has received speaker's fees from Medtronic, Inc. In addition, he was in receipt of a research grant from Medtronic, Inc. to the University of Manchester.
Kenneth A. Ellenbogen, MD
Kontos Professor of Cardiology
Medical College of Virginia
Richmond
VA
Disclosures
KAE declares that he has no competing interests.
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Differentials
- Orthostatic syncope (postural or orthostatic intolerance syncope syndromes)
- Bradycardia
- Bradycardia: AV conduction disorders
More DifferentialsGuidelines
- Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness
- 2018 ESC guidelines for the diagnosis and management of syncope
More GuidelinesPatient information
Atrial fibrillation
Febrile seizures
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