Advanced Evaluation of Cardiac Syncope

Cardiac syncope is a transient loss of consciousness caused by structural heart disease or arrhythmia and is associated with a risk of sudden cardiac death. Causes include bradyarrhythmias (AV block, sinus node dysfunction), tachyarrhythmias (VT, SVT, AF/flutter), structural disease (aortic stenosis, HCM), pulmonary embolism and coronary disease.

Advanced evaluation includes detailed history, physical examination, orthostatic blood pressure measurement, ECG, echocardiography, ambulatory monitoring (Holter, event recorder, implantable loop recorder), tilt-table testing, electrophysiology study and, when indicated, cardiac MRI or CT.

Prolonged or exertional syncope, syncope with palpitations, a family history of sudden death and structural heart disease are considered high-risk features and often warrant an implantable cardiac monitor or ICD.