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Risk Stratification and Prognosis of Vasovagal Syncope in the Emergency Department

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Vasovagal Syncope

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Abstract

  • ED assessment of possible syncope patients follows a three-step approach.

  • Syncope should be confirmed via a detailed history.

  • Underlying causes should be identified and treated accordingly.

  • Finally, stratification according to their risk of serious future adverse outcome should take place using clinical judgment, a risk score, or a clinical decision rule.

  • Uncomplicated vasovagal syncope is suggested when there are no features that suggest an alternative diagnosis and no features suggestive of a cardiac cause.

  • Most problems in the ED related to diagnosing vasovagal syncope are caused by patients with atypical vasovagal syncope (i.e., patients without any trigger or prodrome), and patients with symptoms suggestive of vasovagal syncope but with other concerning comorbidities.

  • Nontypical vasovagal syncope can be defined as a TLoC not preceded by an evident trigger, positive tilt test, and absence of any competing diagnosis.

  • Posture, provoking factors, and prodromal symptoms are most predictive of vasovagal syncope.

  • Two vasovagal prediction tools exist which may help diagnosis.

After reassurance, it must be explained to patients diagnosed with vasovagal syncope that their prognosis is good, the mechanisms causing their syncope, possible trigger events, and avoidance strategies.

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Author information

Authors and Affiliations

  1. Emergency Medicine Research Group Edinburgh (EMeRGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK

    Matthew J. Reed

  2. Medicina a Indirizzo Fisiopatologico, Dipartimento di Medicina Interna, Ospedale “L. Sacco”, Università degli Studi di Milano, Milan, Italy

    Giorgio Costantino

Authors
  1. Matthew J. Reed
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  2. Giorgio Costantino
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Corresponding author

Correspondence to Matthew J. Reed .

Editor information

Editors and Affiliations

  1. Section of Cardiology, Ospedale Privato Quisisana, Ferrara, Italy

    Paolo Alboni

  2. Department of Medicine - BIOMETRA, Humanitas Research Hospital, Rozzano, Milan, Italy

    Raffaello Furlan

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Reed, M.J., Costantino, G. (2015). Risk Stratification and Prognosis of Vasovagal Syncope in the Emergency Department. In: Alboni, P., Furlan, R. (eds) Vasovagal Syncope. Springer, Cham. https://doi.org/10.1007/978-3-319-09102-0_18

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  • DOI: https://doi.org/10.1007/978-3-319-09102-0_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09101-3

  • Online ISBN: 978-3-319-09102-0

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