BMJ Best Practice Podcast Syncope
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Apr 26, 2024 Shamai Grossman, Associate Professor of Medicine and Emergency Medicine at Harvard Medical School, dives into the complexities of syncope. He highlights its prevalence, accounting for significant emergency visits. Grossman emphasizes the importance of history and witness accounts in diagnosis, warns against over-testing, and discusses effective management strategies, including risk assessment and monitoring options. He also addresses common misconceptions and offers insights on managing syncope in specific populations, such as pregnant women and the elderly.
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Prioritise History Over Routine Tests
- Obtain a focused history; it yields a diagnosis in ~45% of cases and is the most valuable diagnostic tool.
- Use an ECG selectively because it only adds ~5% diagnostic yield beyond history.
Only Test For Concerning Concomitant Signs
- Avoid routine broad testing for every syncope patient; tests rarely change management.
- Reserve imaging or labs for specific concurrent symptoms (e.g., headache, pleuritic chest pain).
Age Alone Shouldn't Drive Admission
- Older age alone should not drive automatic admission or extensive workup for syncope.
- Over-admission exposes patients to harm without improving 30-day outcomes when evaluation is non‑worrisome.