In patients with an abnormal ECG or findings on history or physical examination suggesting a cardiac etiology of syncope or presyncope, transthoracic echocardiography can be used to assess for structural heart disease or to help identify risk factors for malignant arrhythmias and is validated by multiple studies and supported by numerous societies [3,8,67-69]. Possible etiologies include various cardiomyopathies, valvular disease, pericardial disease, and tumors. US Echocardiography Transthoracic Stress There are no prospective studies that examine the use of transthoracic stress echocardiography in patients with cardiac etiology for syncope or presyncope. Stress echocardiography can be used to assess for left ventricular outflow obstruction in patients with left ventricular hypertrophy and hypertrophic cardiomyopathy. In both of these populations, outflow tract obstruction is associated with increased future episodes of presyncope and syncope [70,71]. Variant 2: Presyncope or syncope. Low probability of cardiovascular etiology based on history, physical examination, and ECG findings. Initial imaging. CT Head Serial studies of patients with syncope or presyncope have shown that CT head does not influence treatment management in this clinical scenario [15-19]. CT Heart Function and Morphology There is no relevant literature that examines the use of ECG-gated CT heart in this clinical scenario. CTA Chest There is no relevant literature that examines the use of CTA of the chest in this clinical scenario. CTA Coronary Arteries There is no relevant literature that examines the use of ECG-gated CCTA in this clinical scenario. Syncope MRI Head There is no relevant literature to support the use of head MRI in this clinical scenario. MRI Heart Function and Morphology There is no relevant literature that examines the use of cardiac MRI in this clinical scenario. Radiography Chest There are no prospective studies that examine the use of chest radiographs in patients with syncope or presyncope.
Syncope. In patients with an abnormal ECG or findings on history or physical examination suggesting a cardiac etiology of syncope or presyncope, transthoracic echocardiography can be used to assess for structural heart disease or to help identify risk factors for malignant arrhythmias and is validated by multiple studies and supported by numerous societies [3,8,67-69]. Possible etiologies include various cardiomyopathies, valvular disease, pericardial disease, and tumors. US Echocardiography Transthoracic Stress There are no prospective studies that examine the use of transthoracic stress echocardiography in patients with cardiac etiology for syncope or presyncope. Stress echocardiography can be used to assess for left ventricular outflow obstruction in patients with left ventricular hypertrophy and hypertrophic cardiomyopathy. In both of these populations, outflow tract obstruction is associated with increased future episodes of presyncope and syncope [70,71]. Variant 2: Presyncope or syncope. Low probability of cardiovascular etiology based on history, physical examination, and ECG findings. Initial imaging. CT Head Serial studies of patients with syncope or presyncope have shown that CT head does not influence treatment management in this clinical scenario [15-19]. CT Heart Function and Morphology There is no relevant literature that examines the use of ECG-gated CT heart in this clinical scenario. CTA Chest There is no relevant literature that examines the use of CTA of the chest in this clinical scenario. CTA Coronary Arteries There is no relevant literature that examines the use of ECG-gated CCTA in this clinical scenario. Syncope MRI Head There is no relevant literature to support the use of head MRI in this clinical scenario. MRI Heart Function and Morphology There is no relevant literature that examines the use of cardiac MRI in this clinical scenario. Radiography Chest There are no prospective studies that examine the use of chest radiographs in patients with syncope or presyncope.