[Diagnostic strategy and prognostic significance of syncope in patients with organic heart disease].

Chronic heart failure (CHF) is a very serious problem in the health care systems of all developed countries. Immense progress that has been made in medical sciences for the last twenty years, has not only caused remarkable lifespan prolongation, but has also resulted in increasing number of patients suffering from CHF. One of the most common chronic heart failure symptoms is syncope. Pathophysiologic background of this phenomenon is complicated and frequently connected with heart failure cause. It has been proved in a few studies that syncope in CHF patients is a unfavorable prognostic factor and can be a predictor of sudden cardiac death. Patients demonstrating syncope and suspected of organic heart disease should undergo echocardiographic examination, prolonged electrocardiographic monitoring and if necessary - electro-physiological study. Patients reporting chest pain suggestive of ischeamia before or after loss of consciousness should udergo an electrocardiographic stress test as a first evaluation step. The most probable mechanism of syncope in patients with structural heart disease is arrhythmia. It has been proven that patients with heart disease-related syncope have higher mortality rates than population without structural heart abnormalities. Higher incidence of sudden cardiac death in CHF patients experiencing syncope should not be forgotten by the physician. All causes of syncope should be carefully diagnosed, especially in this population. It may help to administer appropriate treatment and reduce sudden cardiac death risk.