[The importance of anamnesis in differential diagnosis of reflex and cardiogenic syncope].

UNLABELLED: 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. METHODOLOGY: 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. OUTCOME: 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. CONCLUSION: 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.