Syncope: Clinical Study and Outcome of Diagnostic Evaluation.

Background: Syncope is a common clinical presentation in emergency department. The diagnostic workup for syncope causes significant man-hour loss and expensive investigations. Most often the battery of investigations does not lead to any conclusive diagnosis.

Materials and Methods: This was a descriptive study in which included 50 consecutive patients with the diagnosis of syncope. These patients were admitted to a tertiary care hospital between Sep 2009 to Aug 2011. Patients of both sexes above 12 years of age were included in the study. The patients were evaluated on the basis of history, clinical examination, ECG, TMT (for exertional syncope), 2DECHO, HUTT, Holter monitoring and EEG.

Results: Mean age of males were 46.11 yrs and that of females were 41.33 years (confidence interval 95%). Out of 50 patients, 38 were males and 12 were females. The percentages of co morbidities in our sample population were CAD- 6.90%, CVA- 1.72%, Hypertension- 17.24%, APD- 1.72%, Dyslipidemia- 3.45%, Hypothyroidism- 3.45%, RHD with Mitral Stenosis- 1.72%, Type 2 Diabetes Mellitus- 5.17% and no co morbidities in 55.17%. Out of 50 patients 30% had some or the other diagnosis rest 70% patients had no definitive diagnosis. 90% of the patients had cardiogenic syncope and rest 10% had non-cardiogenic syncope. None of the patients in our sample population had orthostatic hypotension. In our study 15 (30%) patients had history of recurrent syncope. On evaluation with ECG, 4 patients had Bundle Branch Block rest 46 had normal ECG. In 96% of the patients 2 DECHO was normal. Holter monitoring revealed Supraventricular tachycardia only in 2 patients. Out of 15 patients of explained syncope 10 had positive HUTT (66.7%) whereas 5 had negative HUTT (33.3%); compared to 35 patients with unexplained syncope HUTT was inconclusive. Neurological evaluation revealed no abnormal EEG though it was our exclusion criteria.

Conclusion: While evaluating syncope most often the battery of investigations does not lead to any conclusive diagnosis. There was male predominance in presentation. Out of 50 patients 10% had cardiogenic, 20% had neurocardiogenic and in 70% diagnosis was not established. Only 20% had HUTT positive. Echocardiography is the investigation of choice in patients of valvular heart disease. A thorough clinical evaluation is must, investigations are of limited value.