Cardiac causes of syncope

Syncopes are caused by a wide variety of diseases of the nervous system and the heart. Suggesting cardiac causes of syncopes, the most important diffe rential diagnosis are bradycardia (including pacemaker malfunction), tachyc ardia, valvular heart diseases, heart failure due to coronary artery diseas e with or without infarction, hypertension, myocarditis or cardiomyopathy. Atrial fibrillation is associated with neurological events, systemic emboli probably arising in the left ventricle must be suspected after myocardial (mural thrombus) or in case of severe left ventricular dysfunction. Many di agnostic tests are available for elevation of syncope: electrocardiogram, H olter monitoring from 24 to 72 hours, echocardiography (including transesop hageal echocardiography). Upright tilt testing may be useful in evaluation of recurrent syncope of unknown cause in patients without organic heart dis ease. If symptoms are recurrent but too infrequent for Hotter monitoring te chniques an implantable loop recorder is useful in detecting dysrhythmias.