CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

October 24th, 2012

Syncope Patients with a Normal ECG Are Unlikely to Have Structural Heart Disease

In a recent study, no syncope patients admitted with a normal electrocardiogram had any abnormality on transthoracic echocardiogram.

Although the differential diagnoses for syncope are myriad, most patients who present with syncope and are evaluated in an emergency department (ED) observation unit are discharged with no diagnosis and no identified cause of the syncopal episode. In a recent Annals of Emergency Medicine study, researchers conducted a retrospective chart review of 323 consecutive patients admitted to a single ED observation unit after a syncopal episode in order to evaluate the utility of structural evaluation of the heart by echocardiography.

Overall, 294 patients (91%) underwent echocardiography (transthoracic in 270, stress in 24). Of 267 patients who presented with normal electrocardiogram (ECG) results, 235 underwent transthoracic echocardiography and none had structural heart disease identified on echocardiogram. One patient had a positive troponin, two patients showed evidence of ischemia on stress echocardiogram, and two patients exhibited transient dysrhythmia while being monitored. Of 56 patients who presented with abnormal ECGs, 35 underwent transthoracic echocardiography and 7 (20%) were abnormal.

Comment: In patients who present with syncope with a normal ECG and who rule out for acute coronary syndromes do not need an echocardiogram as part of their evaluation.

— Richard D. Zane, MD, FAAEM

Reprinted with permission from Journal Watch Emergency Medicine

Categories: Uncategorized


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One Response to “Syncope Patients with a Normal ECG Are Unlikely to Have Structural Heart Disease”

  1. David Powell , MD, FACC says:
    October 25, 2012 at 11:03 pm

    Curious that echo “appropriateness” criteria deem a TTE appropriate for syncope “when there are no other signs of cardiovascular disease”. You can miss a myxoma with a normal exam very rarely presenting as syncope.