Syncope is a frequent problem in otherwise healthy young military personnel (MP). Its diagnosis consumes a lot of time and resources, as well as unnecessary tests.
We established a dedicated center for fast track evaluation of MP with syncope with an algorithm based on quick availability of the most useful diagnostic tools for this population.
Methods: Since January 2014 300 MP were evaluated (21.04±4.09 years, 51% females, BMI 23.09±3.98 kg/m2). Past medical history included diabetes (1), hypertension (6), family history of sudden death (25), prior syncope (125).
Results: 288 had normal ECG with PR 136.2±22.67 msec, QTc 394.59±27.94 (4 with QTc ≥ 440msec and 20 with QTC ≤ 360msec), and normal QRS. Brugada-like pattern was present in 13, early repolarization – in 34, 10 had LVH by ECG.
Circumstances of syncope included history suggestive of reflex mediated syncope (RMS) (263), exercise induced (27), supine (4), paliptations (9), no prodrome (15), significant trauma (6), and amnesia (2).
Tests included 24 hour holter in 67, echo – 106, tilt test – 232, ergometry – 68, adenosine test – 4, ajmaline test – 14, EPS -1, and loop recorder - 4. 6 patients had 6 different tests, 14 – 5 tests, 38 – 4 tests, 67– 3 tests, 49 – 2 tests and 126 had only 1 test.
258 patients were diagnosed as RMS, 2 - orthostatic hypotension; 2 - pseudosyncope; vertigo, psychogenic, anemia, and epilepsy were each diagnosed in one. Only 33 (11%) remain undiagnosed.
Conclusion: In this young healthy MP a dedicated algorithm based on rapid availability of more useful diagnostic tools enables quick workup of syncope with efficient use of diagnostic tests and high rate of diagnosis within a short time. RMS is the diagnosis in the vast majority of cases.
