« Malaise », lipothymie et syncope

Abstract

Fainting and syncope are common medical problems caused by a wide range of diseases. Some disorders are benign problems whereas others are life-threatening illnesses that require rapid diagnosis and emergency care. Initial objective is differentiating those individuals with normal cardiovascular status from those with evidence of cardiac or cardiovascular disease. History and physical examination provide the most important diagnostic information and represent the essential part of the evaluation. Unless the diagnosis is unequivocal, the putative diagnosis should be confirmed by laboratory data. Except electrocardiography, diagnostic tests do not yield diagnostic information in the absence of suggestive clinical findings. In young patients with a syncope of unknown origin, tilt testing should be used as a first-line investigation. Echocardiography is useful in older patients (over 45) in evaluating organic heart disease. With structural heart disease electrophysiology testing has a key role (external or internal loop recorder). Strategies for the evaluation of patients with syncope require utilization of selective and directed diagnostic testing.