The importance of anamnesis in differential diagnosis of reflex and cardiogenic syncope

Česká verzia

Authors: P. Mitro; P. Kirsch; Z. Zausinová
Authors place of work: III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura, Košice, Slovenská republika, prednosta doc. MUDr. Peter Mitro, Ph. D.
Published in the journal: Vnitř Lék 2006; 52(11): 1030-1036
Category: Original Contributions

Summary

The aim of the study was to establish the difference in the anamnestic data in cardiogenic and reflex syncope during a systematic gathering of data using a structured questionnaire and to measure the benefits of structured clinical history in differential diagnosis of syncope.

Methodology:
70 patients with syncope of undetermined etiology (average age 51 years, 26 men and 44 women) underwent a standard diagnostic protocol procedure. Cardiogenic syncope was diagnosed in 16 patients (23 %), vasovagal syncope in 34 patients (49 %), in 20 patients (28 %) the cause of the syncope remained uncertain. Anamnestic data was collected through a structured questionnaire which contained 70 points.

Outcome:
Patients with cardiogenic syncope, as opposed to those with vasovagal syncope, tended to show higher age (68 vs 43 years, p < 0.001), higher occurrence of IHD (75 % vs 35 %, p = 0.008) and hypertension (62 % vs 29 %, p = 0.02). Cardiogenic syncope in the prodromal phase exhibited a more frequent feeling of weakness (43 % vs 14 %, p = 0.02), absence of the typical provoking factor (56 % vs 15 %, p < 0.001), unspecific occurrence during the day (81 % vs 41 %, p = 0.008), and weak pulse according to witness report (50 % vs 8 %, p = 0.01). There was a significantly higher incidence of visual disturbances in vasovagal syncope in the prodromal phase (47 % vs 19 %, p = 0.05) and sweating (29 % vs 6 %, p = 0.05), provoking factors often involved long standing on feet (66 % vs 25 %, p = 0.01) and hunger (29 % vs 0 %, p = 0.01), and paleness was often reported by witnesses as opposed to vasovagal syncope (91 % vs 31 %, p = 0.04). The rate of occurrence of palpitation and nausea in the prodromal phase was identical in both types of syncope.

Conclusion:
There exists a significant difference in anamnestic data of patients with cardiogenic syncope and those with vasovagal syncope. Detailed clinical history is a useful method in differential diagnosis of syncope.

Key words:
syncope – diagnosis – clinical history

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