Syncope : An Evidence-Based Approach

Syncope represents a multidisciplinary issue in medicine, often involving cardiologists, neurologists, emergency medicine specialists, general practitioners , geriatricians and other clinicians. However, terminology, methodology and guidelines differ making the issue more complex. The Editors of this book present a thorough multidisciplinary review of the topic. Guideline-based, they have assembled a team of key opinion leaders in the study and management of syncope. The first section of the book discusses the scientific basis behind the diagnosis and management of syncope going into detail regarding the pathways leading to syncope symptoms and the pathology behind them. The second section of the book then takes a more practical approach defining the practice of syncope management and including a number of case histories explaining the pearls and pitfalls of the current guidelines.

Syncope has many possible causes, but the underlying mechanism of loss of consciousness is transient insufficiency of blood-flow to the brain. The result is a temporary disturbance of brain function causing loss of consciousness and collapse. By virtue of its being due to a self-limited hemodynamic problem resulting for example from a heart rhythm problem, or a drop in blood pressure of other cause, syncope differs from other conditions that cause loss of consciousness. A multidisciplinary approach is likely to be most effective for the evaluation and treatment of syncope; often the expertise of cardiologists, neurologists, emergency medicine specialists, general practitioners, geriatricians and other clinicians is needed. However, unfortunately, each of these sub-specialties have tended to develop and use different terminology, methodology and management guidelines; this has complicated effective interaction among these various care-givers, and has made evaluation and treatment of affected patients more complex. This volume, represents a thorough multidisciplinary review of the subject, offering recommendations based on the guidelines as well as experience derived from the various sub-specialties. It begins by discussing the scientific basis behind the diverse pathophysiology of conditions that may cause syncope, and reviews the optimal clinical management pathways. Later sections of the book then take a more practical approach, defining recommendations for the practice of syncope management through case examples. The most common procedures and tests are discussed along with their indications, methodology, interpretation, and limitations. This book has been designed to fulfill the needs of the wide range of medical practitioners involved in the care of syncope patients. All specialties will benefit from the concentration on the importance of medical history taking. Emergency room physicians and internists will be aided by the focus on risk stratification. Cardiologists and cardiac electrophysiologists will find up-to-date recommendations regarding the indications for and appropriate interpretation of noninvasive and invasive cardiac testing. Neurologists and psychiatrists will find useful the sections exploring the often difficult topic of distinguishing true syncope from other important conditions that may present as transient loss of consciousness.