Intractable syncope

Syncope

Syncope is a common admitting diagnosis to intensive care units; however, in half the cases, the etiology goes undiagnosed. The prognosis is adversely affected in patients with a cardiogenic etiology. We discuss the clinical presentation and pathophysiology of cardiovascular causes of syncope (including arrhythmia and conduction disturbances, myocardial disorders, and valvular disorders), vascular causes (obstruction and decreased venous return), peripheral vascular causes (arterial and venous), and noncardiovascular causes (neurological and hematological). A thorough history and physical examination are the best diagnostic tools. In addition, electrocardiograms and 24-hour telemetry monitoring are also useful. Other diagnostic tests should be ordered judiciously, depending on the findings of the initial evaluation. Medical or surgical treatment is directed at the underlying cause.