Master the board step 3

Cardiology
Syncope Evaluation
The management of syncope is based on 3 criteria:
1. Was the loss of consciousness sudden or gradual?
2. Was the regaining of consciousness sudden or gradual?
3. Is the cardiac exam normal or abnormal?
Syncope
onset
Sudden
Return to
consciousness
Sudden Cardiac exam Normal
Ventricular
arrhythmia
Gradual
Gradual
Abnormal
Toxic-metabolic,
hypoglycemic,
anemic, or hypoxic
etiology
Neurological
etiology
(seizures)
Structural heart
disease: aortic or
mitral stenosis,
HOCM, or mitral
valve prolapse (rare)
Diagnostic Testing
On the initial screen, order the following:
··
Cardiac and neurological examination
··
EKG
··
Chemistries (glucose)
··
Oximeter
··
CBC
··
Cardiac enzymes (CK-MB, troponin)
CCS Tip: Treat special circumstances as follows:
··
If a murmur is present, order an echocardiogram.
··
If the neurological exam is focal or there is a history of head trauma
due to syncope, order head CT.
··
If a headache is described, order head CT.
··
If a seizure is described or suspected, order head CT and EEG.
Carotid Dopplers are not
useful in syncope. A patient
cannot pass out from a
carotid embolus.
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