Abstract
Syncope is defined as a transient, self-limited loss of consciousness due to insufficient
cerebral blood perfusion. In a clinical setting, syncopal events usually present a
diagnostic dilemma due to its broad differential diagnosis ranging from banal to potentially
harmful causes. In the absence of a working hypothesis, multiple tests are ordered
that result in high costs but are of questionable diagnostic and therapeutic value.
This article provides a practical overview and, based on international guidelines
and selected studies, proposes a standardized approach to patients with syncope. Initial
evaluation of these patients includes taking a careful medical history, physical examination
and ECG. These tests result in an individual risk assessment that supports decision-making
whether further analysis should be performed in an outpatient or inpatient setting.
Additional tests including echocardiography, laboratory analysis, cardiac monitoring,
CT-scans, are ordered according to prior evaluation. This article reviews the most
common diagnostic tests, their indications and the clinical relevance for the evaluation
of patients with syncopal events. Therapeutic options are not within the focus of
this article.
Mit einer Lebenszeitprävalenz von 30 – 40 % ist die Synkope ein häufiger Grund für
die Einlieferung auf eine Notfallstation. Aufgrund der vielfältigen Symptome und sehr
breiten Differenzialdiagnose werden oft groß angelegte Abklärungen durchgeführt, die
hohe Kosten generieren, aber für die Ursachenfindung unterschiedlich relevant sind.
In diesem Übersichtsartikel wird ein praktisches und sinnvolles Vorgehen zu Anamnese
und Diagnostik bei Synkopen vorgestellt.
Schlüsselwörter
Synkope - standardisiertes Vorgehen - Erstbeurteilung - Risikostratifikation
Key words
syncope - standardized approach - initial evaluation - risk assessment
