Dr. Michele Brignole,
In this session, three educational cases were presented. The teaching purpose of this session was to show how to apply in real cases the diagnostic algorithm recommended by the most recent 2009 ESC guidelines on syncope. In brief, after the initial evaluation (which consists of history, physical examination and standard ECG), the physician should be able to differentiate between syncopal and non-syncopal causes of transient loss of consciousness, to make a diagnosis if the clinical data allow to do that or, if the nature of syncope remains uncertain, to stratify the short-term risk of life-threatening events and perhaps admit the patient, and perform the most appropriate diagnostic tests. Dr Jean Claude Deharo presented a case of syncope in a patient with recurrent syncope without prodromes, normal heart and normal ECG in which a diagnosis of idiopathic (adenosine-sensitive) syncope was made based on ECG documentation of sudden onset paroxysmal AV block and low values of adenosine plasmatic levels. Dr Andrea Ungar presented a case of unexplained recurrent falls whose mechanism was finally discovered by means of ECG documentation by implantable loop recorder of paroxysmal supraventricular tachycardia. Finally, the nurse practitioner Twani Jetter presented a case of atypical asystolic reflex syncope in whom she could benefit from the utilization of a web-based online interactive decision-making algorithm. After all of the essential information obtained from initial evaluation was entered, the software determined the short-term risk and need for admission, suggested the most likely diagnosis and recommended the appropriate tests to be performed in a sequential manner, resulting in cost-effective practices.
The patient with syncope
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