Prevalence of Pulmonary Embolism Among Patient with Intermediate Risk Syncope, Evaluated in Syncope Unit

Syncope is a common health problem that involves a large part of the population. It was recently published in the New England Journal of Medicine [1] that syncope is not uncommonly one of the first manifestations of pulmonary embolism (PE). We sought to investigate the incidence of PE among intermediate risk syncope (IRS) patients admitted to our syncope unit (SU).

In our hospital all patients after syncope episode are divided into 3 risk groups, and “IRS” patients (with abnormal but not high risk features or acute ECG changes, known mild structural heart disease, syncope during exercise, with sudden onset, or with palpitations just before, trauma caused by event, or age more 65 years) are transferred to SU for one-day fast investigation

From 2014 year 324 patients were hospitalized in SU. Troponin test, echo and holter were performed in each one of them. In the presence of risk factors for PE D-dimer test was done and if D-dimer level was high - CTA was performed (34 cases). One CTA was performed after finding RV dilatation by echo.

All CTA were negative for PE that simultaneously with negative troponin and normаl echo makes unlikely diagnosis of hemodynamically significant embolism as a reason of syncope.

Conclusion:
In our SU the incidence of PE as a cause of syncope is lower than recently published.

Reference:
1. Prandoni P. et al. Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med. 2016 Oct 20; 375(16):1524-1531.