A cross sectional study on prevalence and etiology of syncope in Tehran.
AbstractRecurrent syncope of obscure etiology, particularly in those with structural heart diseases, is associated with higher mortality rates. There are insufficient and conflicting data on prevalence and etiology of syncope in the urban Middle Eastern population. Evaluating the etiologic basis of syncope can be an effective step in prevention of morbidities and sudden cardiac death in susceptible populations. The aim of our study was to determine the prevalence and etiology of syncope in an outpatient cardiology clinic in Tehran the capital of Iran. In this cross sectional study data was collected from patients' records whose first visits were from March 2006 to September 2007 and had undergone thorough examination for syncope (ECG, Holter monitoring, echocardiography, Tilt table testing, Electrophysiological study). All efforts were done to determine underlying heart diseases, physical exam and test abnormalities, final diagnosis and treatment in all selected patients. Overall prevalence of syncope was estimated to be 9%. The age-specific prevalence rates were 5-14 years: 4.14%, 15-44 years: 44.8%, 45-64 years: 31%, 65 years and Older: 20%. The most frequently identified cause (60%) was neurally-mediated (vasovagal) syncope. Mean age of patients was 44.9 years with a minimum of 5 years and maximum of 85 years. In our study, coronary heart disease had a high prevalence among participants (12.4%). Syncope is a common clinical problem. In this study prevalence rates peaked in 15-44 years age group. Considering that recurrent syncope is often disabling and may cause injury and the fact that heart diseases are more common in people affected by syncope, especial cautions should be taken while evaluating this group of patients.
Barsheshet A, Goldenberg I. Cardiovascular syncope: diagnostic approach and risk assessment. Minerva Med 2011;102(3):223-38.
Braunwald's Heart Diseas. 9th edition. 2011. (chapter 42-Hypotension and syncope)
Ebert HH, Walter C, Volkmann H. From loss of consciousness to syncope. Herzschrittmacherther Elektrophysiol 2011;22(2):65-71.
Aguinaga L, Mont L, Anguera I, Valentino M, Matas M, Brugada J. [Patients with structural heart disease, syncope of unknown etiology and inducible ventricular arrhythmias treated with implantable defibrillators]. Rev Esp Cardiol 1998;51(7):566-71.
Link MS, Costeas XF, Griffith JL, Colburn CD, Estes NA 3rd, Wang PJ. High incidence of appropriate implantable cardioverter-defibrillator therapy in patients with syncope of unknown etiology and inducible ventricular arrhythmias. J Am Coll Cardiol 1997;29(2):370-5.
Entem FR, Enriquez SG, Cobo M, Expósito V, Llano M, Ruiz M, Jose Olalla J, Otero-Fernandez M. Utility of implantable loop recorders for diagnosing unexplained syncope in clinical practice. Clin Cardiol 2009;32(1):28-31.
Ouyang H, Quinn J. Diagnosis and evaluation of syncope in the emergency department. Emerg Med Clin North Am 2010;28(3):471-85.
Benditt G, Gert Van Dijk J, Sutton R, Wieling W, Lin J, Sakaguchi S, Lu F. Syncope. Curr Probl Cardiol 2004;29(4):145-229.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med 1997;126(12):989-96.
D'Ascenzo F, Biondi-Zoccai G, Reed MJ, Gabayan GZ, Suzuki M, Costantino G, Furlan R, Del Rosso A, Sarasin FP, Sun BC, Modena MG, Gaita F. Incidence, etiology and predictors of adverse outcomes in 43,315 patients presenting to the Emergency Department with syncope: An international meta-analysis. Int J Cardiol 2013;167(1):57- 62.
Gauer RL. Evaluation of syncope. Am Fam Physician 2011;84(6):640-50.
Schillinger M, Domanovits H, Müllner M, Herkner H, Laggner AN. Admission for syncope: evaluation, cost and prognosis. Wien Klin Wochenschr 2000;112(19):835-41.
Soteriades E, Evans J, Larson M, Chen MH, Chen L, Benjamin EJ,Levy D. Incidence and prognosis of syncope. N Engl J Med 2002;347(12):878–85.
Branch WT Jr. Approach to syncope. J Gen Intern Med 1986;1(1):49–58.
Ungar A, Galizia G, Morrione A, Mussi C, Noro G, Ghirelli L, Masotti G, Rengo F, Marchionni N, Abete P. Two-year morbidity and mortality in elderly patients with syncope. Age Ageing 2011;40(6):696-702.
Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, Wieling W, van Dijk N. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol 2006;17(11):1172-6.
Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Masotti G, Moya A, Raviele A, Sutton R, Theodorakis G, Ungar A, Wieling W; Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope--update 2004. Europace 2004; 6(6):467-537.
Manolis AS, Linzer M, Salem D, Estes NA 3rd. Syncope: current diagnostic evaluation and management. Ann Int Med 1990;112(11):850–63.
Kapoor WN. Evaluation and management of patients withsyncope. JAMA 1992;268(18):2553–60.
Kapoor WN. Work-up and management of patients withsyncope. Med Clin North Am 1995;79(5):1153–70.
Grubb BP, Olshansky B. Syncope: mechanisms and management. Second edition 2005.
Ammirati F, Colivicchi F, Santini M. Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicentre prospective trial - the OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). European Heart Journal 2000;21:935-40.
Chen LY, Shen WK, Mahoney DW, Jacobsen SJ,Rodeheffer RJ. Prevalence of syncope in a population aged more than 45 years. Am J Med 2006;119(12):1088.e1-7.
Da Costa A, Gulian JL, Romeyer-Bouchard C, Messier M, Zarqane N, Samuel B, Khiel A, Isaaz K. Clinical predictors of cardiac events in patients with isolated syncope and negative electrophysiologic study. Int J Cardiol 2006;109(1):28-33.
Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ 2004;329(7461):336-41.
Sule S, Palaniswamy C, Aronow WS, Ahn C, Peterson SJ, Adapa S, Mudambi L. Etiology of syncope in patients hospitalized with syncope and predictors of mortality and rehospitalization for syncope at 27-month follow-up. Clin Cardiol 2011;34(1):35-8.