{"id":32490,"date":"2012-10-24T15:44:21","date_gmt":"2012-10-24T19:44:21","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=32490"},"modified":"2012-10-24T15:44:21","modified_gmt":"2012-10-24T19:44:21","slug":"syncope-patients-with-a-normal-ecg-are-unlikely-to-have-structural-heart-disease","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/10\/24\/syncope-patients-with-a-normal-ecg-are-unlikely-to-have-structural-heart-disease\/","title":{"rendered":"Syncope Patients with a Normal ECG Are Unlikely to Have Structural Heart Disease"},"content":{"rendered":"<p><em>In a recent study, no syncope patients admitted with a normal electrocardiogram had any abnormality on transthoracic echocardiogram.<\/em><\/p>\n<p>Although the differential diagnoses for syncope are myriad, most patients who present with syncope and are evaluated in an emergency department (ED) observation unit are discharged with no diagnosis and no identified cause of the syncopal episode. In a recent<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22632775?dopt=Abstract\"> <em>Annals of Emergency Medicine<\/em> study<\/a>, researchers conducted a retrospective chart review of 323 consecutive patients admitted to a single ED observation unit after a syncopal episode in order to evaluate the utility of structural evaluation of the heart by echocardiography.<\/p>\n<p>Overall, 294 patients (91%) underwent echocardiography (transthoracic in 270, stress in 24). Of 267 patients who presented with normal electrocardiogram (ECG) results, 235 underwent transthoracic echocardiography and none had structural heart disease identified on echocardiogram. One patient had a positive troponin, two patients showed evidence of ischemia on stress echocardiogram, and two patients exhibited transient dysrhythmia while being monitored. Of 56 patients who presented with abnormal ECGs, 35 underwent transthoracic echocardiography and 7 (20%) were abnormal.<\/p>\n<p><strong>Comment:<\/strong> In patients who present with syncope with a normal ECG and who rule out for acute coronary syndromes do not need an echocardiogram as part of their evaluation.<\/p>\n<p><strong><em>\u2014 <a href=\"http:\/\/emergency-medicine.jwatch.org\/misc\/board_about.dtl#aZane\">Richard D. Zane, MD, FAAEM<\/a><\/em><\/strong><\/p>\n<p><em>Reprinted with permission from<\/em> <a href=\"http:\/\/emergency-medicine.jwatch.org\/\">Journal Watch Emergency Medicine<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In a recent Annals of Emergency Medicine study, no syncope patients admitted with a normal electrocardiogram had any abnormality on transthoracic echocardiogram. Journal Watch&#8217;s Richard Zane offers his view here.<\/p>\n","protected":false},"author":343,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-32490","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32490","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/343"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=32490"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32490\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=32490"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=32490"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=32490"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}