[AITFL] Manage of Syncope

The most common causes of syncope are: Unknown (34-36%), Vasovagal (18-21%), and Cardiac (9.5-18%). Soteriades et al noted that if patients have a history of CV disease, the incidence of cardiac etiology also increases.

Causes of Syncope & The Presence or Absence of CV Disease
CV Disease	CV Disease Absent		CV Disease Present
Sex	Male	Female	Male	Female
Cardiac Etiology	6.5%	3.8%	26.7%	16.8%

San Francisco Syncope Rule

The mnemonic for features of the rule is CHESS:

• C - History of congestive heart failure

• H - Hematocrit < 30%

• E - Abnormal ECG

• S - Shortness of breath

• S - Triage systolic blood pressure < 90

What is the ACEP Level-B Recommendation for Admission?

• Older age and associated comorbidities (No set definition) 
• Abnormal EKG findings (acute ischemia, dysrhythmias, or significant conduction abnormalities) 
• Hematocrit <30 
• History or presence of CHF, CAD, or structural heart disease 

Does Everyone with Syncope Need a Head CT?

Bottom Line: Clinicians might consider obtaining a Head CT as part of the syncope evaluation for the following findings:

• Trauma above the clavicle 
• Persistent neurologic deficit or complaint 
• Age >65 
• Sudden onset headache 
• Patients on warfarin (coumadin)