Real Life Experience of a Syncope Clinic Based on a Neurological and Cardiological Collaboration Model

Background: The diagnosis of a syncope patient is a very challenging task. Very often, despite our efforts we fail to unravel the nature and the cause of a syncopal episode. Therefor, during the last two years we have adopted a syncope clinic model which is based on simultaneous patient evaluation by a cardiologist and neurologist.

Methods: A. Retrospective case analysis B. Syncope diagnosis was based on a structured interview, complete neurological and cardiological examination, EEG, EKG, Tilt test, ILR & autonomic nervous system workup when appropriate.

Observations: 59 consecutive patients with presumed syncopal episodes. The majority of patients were hard to diagnose patients for whom previous attempts of diagnosis failed. Mean age was 60 (Sd-22.3) with an age range of 11-96. 36 women & 23 men. 19 patients had a previous cardiological background of whom 14 had arrhythmia. 22 patients had an underlying neurological background such as migraine or stroke. 11 patients underwent Tilt test which was positive in eight of them. Eight patients underwent ILR placement. A conclusive syncope or non syncope diagnosis was reached in 51 patients. A combined multi factorial aetiology was defined in 6 patients with various combinations of orthostatic hypotension, arrhythmia, anxiety, POTS, basilar migraine and Parkinson’s disease. In 16 patients a non syncope diagnosis was reached: dizziness, vertigo, panic disorder, Epilepsy, repeated falls due to a gait abnormality, and sleep attacks. One patient had a peripheral autonomic failure and one patient had a central autonomic failure

Conclusions: The diagnosis of syncope is often complex and defies our best efforts. A simultaneous cardiological and neurological evaluation, although time consuming, increases the chances of a correct diagnosis.