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Etiologic Considerations in the Patient With Syncope and an Apparently Normal Heart
Nora Goldschlager, MD;
Andrew E. Epstein, MD;
Blair P. Grubb, MD;
Brian Olshansky, MD;
Eric Prystowsky, MD;
William C. Roberts, MD;
Melvin M. Scheinman, MD;
for the Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology
Arch Intern Med. 2003;163:151-162.
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INTRODUCTION
Syncope is characterized by a transient loss of consciousness due to cerebral hypoperfusion, loss of postural tone, varying degrees of recall of events surrounding the syncopal spell, and absence of neurologic sequelae. Syncope is extremely common, constituting up to 3% of all visits to emergency departments and up to 5% to 6% of all hospital admissions. A carefully performed history review (including family history) and physical examination (Table 1) of the patient with syncope suggests a diagnosis in about 45% of patients. Many of these patients will have structural heart disease suggested or identified in this manner; in others, this initial evaluation will be unrevealing. Although in some cases the 12-lead . . . [Full Text of this Article]
ORTHOSTATIC HYPOTENSION
NEUROCARDIOGENIC SYNCOPE
CAROTID SINUS HYPERSENSITIVITY AND CAROTID SINUS SYNDROME
SYNCOPE IN PATIENTS WITH SUPRAVENTRICULAR TACHYCARDIA
VENTRICULAR ARRHYTHMIAS IN NORMAL HEARTS
VT Arising From the Right Ventricular Outflow Tract Idiopathic Left Ventricular Arrhythmias Arrhythmogenic Right Ventricular Dysplasia Long QT Syndromes and Torsades de Pointes VT Other Pharmacologic Causes of Ventricular Arrhythmias and Syncope The Brugada Syndrome
CONGENITAL COMPLETE ATRIOVENTRICULAR BLOCK
CORONARY ARTERIAL ANOMALIES
SYNCOPE IN THE ATHLETE
PHYSIOLOGY OF EXERCISE AND RELATIONSHIP TO SYNCOPE
From the Cardiology Division, San Francisco General Hospital, San Francisco, Calif (Drs Goldschlager); Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham (Dr Epstein); Medical College of Ohio, Cardiology, Ruppert Health Center, Toledo (Dr Grubb); Cardiology Division, University of Iowa Hospital and Clinics, Iowa City (Dr Olshansky); the Care Group, Indianapolis, Ind (Dr Prystowsky); Baylor University Medical Center, Dallas, Tex (Dr Roberts); and the Electrophysiology Division, University of California, San Francisco (Dr Sheinman).
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