[The importance of anamnesis in differential diagnosis of reflex and cardiogenic syncope].
The aim of the study was to establish the difference in the anamnestic data in cardiogenic and reflex syncope during a systematic gathering of data using a structured questionnaire and to measure the benefits of structured clinical history in differential diagnosis of syncope.


METHODS
70 patients with syncope of undetermined etiology (average age 51 years, 26 men and 44 women) underwent a standard diagnostic protocol procedure. Cardiogenic syncope was diagnosed in 16 patients (23%), vasovagal syncope in 34 patients (49%), in 20 patients (28%) the cause of the syncope remained uncertain. Anamnestic data was collected through a structured questionnaire which contained 70 points.


RESULTS
Patients with cardiogenic syncope, as opposed to those with vasovagal syncope, tended to show higher age (68 vs. 43 years, p < 0.001), higher occurrence of IHD (75% vs. 35%, p = 0.008) and hypertension (62% vs. 29%, p = 0.02). Cardiogenic syncope in the prodromal phase exhibited a more frequent feeling of weakness (43% vs. 14%, p = 0.02), absence of the typical provoking factor (56% vs. 15%, p < 0.001), unspecific occurrence during the day (81% vs. 41%, p = 0.008), and weak pulse according to witness report (50% vs. 8%, p = 0.01). There was a significantly higher incidence of visual disturbances in vasovagal syncope in the prodromal phase (47% vs. 19%, p = 0.05) and sweating (29% vs. 6%, p = 0.05), provoking factors often involved long standing on feet (66% vs. 25%, p = 0.01) and hunger (29% vs. 0%, p = 0.01), and paleness was often reported by witnesses as opposed to vasovagal syncope (91% vs. 31%, p = 0.04). The rate of occurrence of palpitation and nausea in the prodromal phase was identical in both types of syncope.


CONCLUSIONS
There exists a significant difference in anamnestic data of patients with cardiogenic syncope and those with vasovagal syncope. Derailed clinical history is a useful method in differential diagnosis of syncope.
Mitro
P
P
III interná klinika Lekárskej fakulty UPJS a FN L. Pasteura, Kosice, Slovenská republika. pmitro@lf.upjs.sk
Kirsch
P
P
Zausinová
Z
Z
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013575:Syncope / Q000209:etiology*; D019462:Syncope, Vasovagal / Q000209:etiology*