Syncope in Young Women: Broadening the Differential Diagnosis

Authors

Nachiket Patel, Banner/University of Arizona College of Medicine, Phoenix, AZ.
Naila Choudhary, Rochester Regional HealthFollow
Christine Tompkins, University of Colorado School of Medicine, Aurora, CO.
Khawaja Afzal Ammar, Aurora Medical Center, Milwaukee, WI.
A Jamil Tajik, Aurora Medical Center, Milwaukee, WI.
Krishnaswamy Chandrasekaran, Mayo Clinic, Rochester, MN.
Timothy E. Paterick, Aurora Medical Center, Milwaukee, WI.

Department

Cardiology

Document Type

Article

Publication Title

Reviews In Cardiovascular Medicine

Abstract

Syncope is defined as a sudden transient loss of consciousness (TLOC) with concomitant loss of postural tone followed by spontaneous recovery. It is a subset of a broader class of medical conditions, including postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and neurally mediated syncope (NMS), that may result in TLOC. The overlap of these clinical conditions leads to confusion regarding syncope classification that can hinder evaluation strategies, and pose challenges for diagnosis and treatment, particularly in young women. In this article, we review POTS, orthostatic hypotension, and NMS with an emphasis on NMS. These diverse orthostatic clinical entities may be associated with syncope and are frequently observed in young, healthy women. The importance of considering NMS as a diagnosis of exclusion cannot be overstated. We report a series of three young, otherwise healthy women, initially diagnosed with NMS, whose clinical course evolved over time into more sinister diagnoses that were overlooked and associated with devastating clinical outcomes. These cases highlight the importance of maintaining a broad differential diagnosis when considering the diagnosis of NMS. Each case synopsis provides key clinical features that must be considered to avoid overlooking more serious clinical conditions.

First Page

100

Last Page

114

DOI

10.3909/ricm0865

Volume

18

Issue

3

Publication Date

1-1-2017

Medical Subject Headings

Adolescent; Age Factors; Blood Pressure; Diagnosis, Differential; Electrocardiography; Female; Humans; Hypotension, Orthostatic (diagnosis, epidemiology, physiopathology, therapy); Postural Orthostatic Tachycardia Syndrome (diagnosis, epidemiology, physiopathology, therapy); Predictive Value of Tests; Prognosis; Risk Factors; Sex Factors; Syncope, Vasovagal (diagnosis, epidemiology, physiopathology, therapy); Young Adult

PubMed ID

29111543

Recommended Citation

Patel, N., Choudhary, N., Tompkins, C., Ammar, K. A., Tajik, A. J., Chandrasekaran, K., & Paterick, T. E. (2017). Syncope in Young Women: Broadening the Differential Diagnosis. Reviews In Cardiovascular Medicine, 18 (3), 100-114. https://doi.org/10.3909/ricm0865