Choosing your syncope work-up wisely.
WHAT ARE SOME RED FLAGS IN SYNCOPE?
Syncope is common, occurring in up to 30% of the adult population at some stage in their life. Common things being common, it could very well show up on your exam, and it will show up in your future practice.
Your job, if you choose to accept it, is to decide who needs that urgent head CT and who you can wisely choose to receive an ECG with thorough history and physical and discharge home. Before scrolling down for some answers, can you accept the mission and try and name 3 RED FLAGS for Syncopal patients that would require more work up than just an ECG?
DID YOU KNOW CHOOSING WISELY CANADA recommends not routinely obtaining neuroimaging (CT/MRI/US-Carotid) in the evaluation of syncope in patients with normal neurological examination.
1. Seizure activity
2. History/Signs of CVD (Aortic Stenosis, MI, HF)
3. Exertional syncope
4. ECG changes
5. Palpitations concurrent with syncope
6. Family Hx of sudden cardiac death
7. New neurologic signs
8. No prodrome
EXAM TIP – On the exam you have to Choose Wisely while at the same time make sure you know the RED FLAGS for more urgent investigation and possibly intervention. During residency take the time to take a moment after a patient encounter and write down in your note what RED FLAGS you screened for as way to study for the exam.
Christine Soong, Benjamin H. Chen, and Brian M. Wong. Decisions: A 62-year- old woman with syncope. CMAJ January 6, 2015 187:48-49; published ahead of print December 1, 2014, doi:10.1503/cmaj.141313.
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