History of Presenting Illness Physical Examination Basic Investigation Management Diagnosis Treatment Prognosis & Evidence-Based Info Summary Questions

The following describes six different methods of managing the patient. Which would you pursue? Click on each link to determine the results of your evaluation.

  1. Send home, stop Timolol and arrange for Holter monitor or Loop Recorder
    • Since the patient was not advised of the danger of driving related to syncope, she did not stop driving once she was sent home. As a result the patient was involved in a motor vehicle accident; investigation revealed that she had “blacked out at the wheel”.
    • Click here to learn more about the Holter Monitor.
    • Click here to learn more about the Loop Recorder.
  1. Electrophysiology Study
  2. Tilt Table Test
  3. Echocardiogram
  4. Admit and monitor
  5. Electroencephalograph

Loop recorders: may be external, or implantable (placed under the skin).

  • Implantable loop recorders (ILR) were evaluated against external loop recorders, tilt-table testing, and electrophysiology testing, in a recent study involving 60 patients with unexplained syncope.
  • A diagnosis was reached in 55% of patients when ILR was used, compared to 19% of patients using other diagnostic methods, leading some investigators to suggest earlier use of ILR as a diagnostic tool.