0071643192.pdf

DIAGNOSIS

■ A complete history and exam are critical to guide the ordering of tests.
■ ECG should be done in all cases to screen for underlying cardiovascular
disease, dysrhythmias, presence of familial disorder (eg, Brugada syndrome;
see Figure 2.21) or electrolyte abnormalities.
■ Echocardiography: To screen for underlying cardiovascular disease if diag-
nosis remains unclear
■ Patients at high risk for cardiac etiology:
■ Age> 45
■ History of ventricular dysrhythmias

CARDIOVASCULAR EMERGENCIES

TABLE 2.26. Classic Presentations of Syncope

PRESENTATION SUSPECTEDDIAGNOSIS

17-year-old male, syncope during running Hypertrophic cardiomyopathy

29-year-old female, syncope and abdominal pain Ectopic pregnancy

68-year-old male, syncope and abdominal or flank pain Abdominal aortic aneurysm

34-year-old female, sudden severe headache and syncope Subarachnoid hemorrhage

72-year-old male with history of MI and CHF, Dysrhythmia

syncope at home

40-year-old female, syncope while standing in line, Vasovagal

prodrome of nausea, sweating, warmth

78-year-old female with cancer, sudden onset of PE

SOB and syncope

FIGURE 2.21. Typical ECG of Brugada syndrome.

(Reproduced, with permission, from Fuster V, Alexander RW, O’Rourke, RA. Hurst’s The
Heart, 12th ed. New York: McGraw-Hill, 2008:1837.)