Shortness of breath, chest pain, palpitations, exercise-associated syncope
Organic heart disease
May have bradycardia or tachycardia, cyanosis
Organic heart disease
Diagnostics for Organic heart disease?
Refer
Palpitations; absence of other symptoms
Arrhythmias
Loud S2, S3; murmur, lift
Arrhythmias
Diagnostics for Arrhythmias
Electrocardiogram, Holter monitor, echocardiogram Doppler studies, cardiac stress testing
Emotional event, standing for long periods, crowded room, warm environment
Vasovagal
Physical Findings for Vasovagal?
None
Diagnostics for Vasovagal?
Tilt-table testing, CSM
Occurs with cough, micturition, defecation, swallowing
Situational
Physical Findings for Situational?
None
Diagnostics for Situational?
None
Children 6 mo to 5 yr; associated with anger, pain, brief cry; breath-holding LOC; may have twitching
Breath holding
Cyanosis or pallor
Breath holding
Diagnostics for Breath holding?
None
Anxiety- or fear-induced event, shortness of breath
Hyperventilation
Physical Findings for Hyperventilation?
None
Diagnostics for Hyperventilation?
None
History of asthma; coughing paroxysm awakens child from sleep, becomes flaccid with clonic muscle spasm, LOC
Cough syncope
Physical Findings for Cough syncope?
Wheezes
Diagnostics for Cough syncope?
none
Position change from lying/sitting to standing, pregnancy, prolonged bed rest
Orthostatic hypotension
Hypotension on testing orthostatic blood pressure
Orthostatic hypotension
Diagnostics for Orthostatic hypotension?
20-mm Hg drop insystolic pressureon standing
History of antidepressants, antiarrhythmic agents, (B-blockers, or diuretics
Prescribed medications
Depends on underlying condition
Prescribed medications
Diagnostics for Prescribed medications?
none
History of use of illicit drugs
Drug-induced causes
Arrhythmia may be present
Drug-induced causes
Diagnostics for Drug-induced causes?
Toxicology screen
Headache, vomiting, photophobia, positive family history
Migraine
Usually none; nystagmus, photophobia
Migraine
Diagnostics for Migraine?
none
Convulsions, incontinence, postictal phase
Seizures
Usually none; nystagmus
Seizures
Diagnostics for Seizures?
Electroencephalogram
Symptoms consistent with depression, anxiety, panic
Mental disorder
Physical findings Mental disorder?
None
Diagnostics for Mental disorder?
Psychiatric evaluation
Adolescent, event occurs with audience present; gentle fall, memory of incident exact
Hysterical reaction
Physical findings hysterical reaction?
none
Diagnostics for Hysterical reaction?
none
No diagnostic characteristics
Unknown Causes
Physical findings of unknown causes?
none
Diagnostics for Unknown Causes?
Workup normal results