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Syncope

Syncope Woman

Fainting and Blackouts Should
be taken
to heart

25% of unexplained fainting has a cardiac cause,1 but if you don’t screen, it could stay unseen.

The Challenge

DIAGNOSING PATIENTS AT RISK OF  CARDIAC SYNCOPE

The video below provides insights from Heart Rhythm Specialist, Dr Brad Wilsmore on the challenge of diagnosing syncope and importance of identifying cardiac risk factors. 

Fill in your details in the form provided to view the complete education video as well as a patient cardiac risk assessment checklist and additional resources.

Receive your copy of 'The Challenge of Diagnosing Syncope' resources

THE CHALLENGE OF SYNCOPE

Fainting and blackouts, also know as Syncope are a common problem. Up to 35% of the population will have at least one faint during their lifetime.6 In Australia, fainting is the 5th most common cause of hospitalisation from the Emergency Department.7 Yet, half of those admitted to the hospital leave without a diagnosis.12 People faint for many reasons, and in some people it can be a sign of an underlying heart condition.
Graph showing the different causes of Syncope

The Cause Remains Unexplained

In 1/3 of Syncope patients, the cause remains unexplained3.

25% of Patients with unexplained fainting1 are identified to have a cardiac cause  following long term monitoring with An insertable cardiac monitor (ICM).  

Syncope with a cardiac cause increases mortality rates:

  • 2X increased risk of death4
  • >10% mortality rate at six months5

 FEATURES THAT MAY SUGGEST A CARDIAC CAUSE (ESC GUIDELINES)13

SYNCOPE EVENTS

  • New symptoms of chest or abdominal pain, breathlessness, headache.
  • No warning signs or short ( < 10sec) prodrome.
  • Sudden onset of palpitations followed by syncope.
  • Syncope during exertion.
  • Syncope when supine or sitting.

EXAMINATION

  • Systolic blood pressure< 90 mm Hg.
  • Persistent bradycardia ( <40bpm) in awake state and absence of training.
  • Undiagnosed systolic murmur.
  • Abnormal ECG.
  • Occupational risk to patient.
  • Injury caused by syncope.

MEDICAL HISTORY

  • Structural heart disease or coronary artery disease (e.g. heart failure, low LV ejection fraction, previous myocardial infarction).
  • Family history of sudden cardiac death.

SYNCOPE RESOURCES AND GUIDELINES

Syncope Patient Checklist
Guideline recommendation for cardiac syncope
The role of the cardiologist and the electrophysiologist

Syncope Patient Checklist

Download our Syncope patient checklist to assess cardiac cause in your patients.

Request a copy of the Patient Checklist (opens new window)

Guideline recommendations for cardiac Syncope

 Download a summary of the cardiac monitoring recommendations. 

Request a copy of the Summary of recommendations (opens new window)

The Role of a Cardiologist and Electrophysiologist

Watch Dr Bradley Wilsmore outlying the role of a Cardiac Electrophysiologist in cardiac rhythm assessment and management.

Request to view the video (opens new window)

IF YOU SUSPECT A CARDIAC CAUSE RELATED TO SYNCOPE EVENTS

Refer to a Heart Rhythm Specialist

LEARN MORE ABOUT UNEXPLAINED SYNCOPE

Visit Website (opens new window)
1

Ganzeboom KS, et al. J Cardiovasc Electrophysiol. 2006;17:1172-1176.

2

Solbiati M, etal. The diagnostic yield of implantable loop recorders in unexplained syncope: A systematic review and meta-analysis. Int J Cardiol. 2017 Mar 15;231:170-176. doi: 10.1016/j.ijcard.2016.12.128. Epub 2016 Dec 22. PMID: 28052814.

3

Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, Levy D. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85. doi: 10.1056/NEJMoa012407. PMID: 12239256

4

Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, Levy D. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85. doi: 10.1056/NEJMoa012407. PMID: 12239256

5

Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, Levy D. Incidence and prognosis of syncope. N Engl J Med. 2002 Sep 19;347(12):878-85. doi: 10.1056/NEJMoa012407. PMID: 12239256

6

Ganzeboom KS, et al. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol. 2006;17:1172-1176.

7

Australian Institute of Health and Welfare 2018. Emergency department care 2017–18: Australian hospital statistics. Health services series no. 89. Cat. no. HSE 216. Canberra: AIHW.

8

Brignole M, etal. 2018 ESC Guidelines for the diagnosis and management of syncope, European Heart Journal, Volume 39, Issue 21, 01 June 2018, Pages 1883–1948, .

9

Shen WK. et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2017 Aug;14(8):e155-e217. doi: 10.1016/j.hrthm.2017.03.004. Epub 2017 Mar 9. PMID: 28286247

10

Brignole M, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013 Aug;34(29):2281-329. doi: 10.1093/eurheartj/eht150. Epub 2013 Jun 24. PMID: 23801822.

11

National Institute for Health and Clinical Excellence, Transient loss of consciousness ('blackouts') in over 16s, Clinical Guideline [CG109], Published date: 25 August 2010 Last updated: 01 September 2014,  www.nice.org.uk.

12

Data obtained from CDC National Hospital Ambulatory Medical Care Survey (NHAMCS) from the years 2008-2014.

13

Brignole,  M etal; 2018 ESC Guidelines for the diagnosis and management of syncope, European Heart Journal, Volume 39, Issue 21, 01 June 2018, Pages 1883–1948, https://doi.org/10.1093/eurheartj/ehy037.