Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA.
Ann Emerg Med. 2012 Oct;60(4):478-84.e1. doi: 10.1016/j.annemergmed.2012.04.023. Epub 2012 May 25.
Patients with syncope are frequently managed in observation units and receive serial examinations, monitoring for arrhythmias, and structural analysis of the heart. The primary aim of this study is to determine the utility of structural analysis of the heart in syncope patients who are being managed in an observation unit and have a normal ECG result.
This is a retrospective, observational chart review of all consecutive adult patients observed during 18 months at an urban, academic medical center. A case report form with demographics, ECG interpretations, and structural analysis of the heart data was generated and all variables were defined before data extraction. Subjects with an ECG demonstrating any arrhythmia, premature atrial contraction, premature ventricular contraction, pacing, second- and third-degree blocks, and left bundle branch block were excluded from the normal ECG group. An abnormal cardiac structure was defined as an ejection fraction less than 45%, severe hypertrophy, or severe valvular abnormality. Ten percent of cases were evaluated by a second extractor to verify accuracy. Descriptive statistics with confidence intervals (CIs) and interquartile ranges (IQRs; 25%, 75%) are used.
Three hundred twenty-three subjects were managed in the observation unit for syncope, 48% were men, and their median age was 66 years (25%, 75% IQR 52, 80). Two of 323 (0.6%; 95% CI 0.2% to 2.2%) had an arrhythmia; 1 of 323 had a non-ST-segment myocardial infarction (0.3%; 95% CI 0.1% to 1.7%). Of the 323 patients, 267 had a normal ECG result and 235 (88%) had their cardiac structure evaluated. Forty-eight percent of the normal ECG group were men, and the median age was 65 years (25%, 75% IQR 52, 79). Zero of 235 patients (0%; 95% CI 0% to 1.6%) had a structural abnormality identified on evaluation, and 2 of 18 (11%; 95% CI 3.1% to 32.8%) had an abnormal stress echocardiogram result.
Structural abnormalities are unlikely in syncope patients with a normal ECG result. Care should focus on excluding arrhythmias and acute coronary syndrome.
晕厥患者常被收入观察病房，并接受连续检查、心律失常监测和心脏结构分析。本研究的主要目的是确定在观察病房接受治疗且心电图正常的晕厥患者进行心脏结构分析的效用。
这是一项对在城市学术医疗中心观察 18 个月的所有连续成年患者进行的回顾性、观察性图表回顾。生成了一份病例报告表，其中包括人口统计学数据、心电图解读和心脏结构分析数据，并且在提取数据之前定义了所有变量。从正常心电图组中排除了心电图显示任何心律失常、房性早搏、室性早搏、起搏、二度和三度阻滞以及左束支传导阻滞的患者。异常心脏结构定义为射血分数<45%、严重肥大或严重瓣膜异常。10%的病例由第二名提取员进行评估以验证准确性。采用置信区间（CI）和四分位距（IQR；25%，75%）进行描述性统计。
323 例患者因晕厥被收入观察病房，48%为男性，中位年龄为 66 岁（25%，75%IQR 52，80）。323 例患者中有 2 例（0.6%；95%CI 0.2%至 2.2%）发生心律失常，323 例患者中有 1 例（0.3%；95%CI 0.1%至 1.7%）发生非 ST 段抬高型心肌梗死。323 例患者中，267 例心电图正常，235 例（88%）进行了心脏结构评估。正常心电图组中 48%为男性，中位年龄为 65 岁（25%，75%IQR 52，79）。235 例患者中无一例（0%；95%CI 0%至 1.6%）发现结构性异常，18 例患者中有 2 例（11%；95%CI 3.1%至 32.8%）异常应激超声心动图结果。
心电图正常的晕厥患者不太可能存在结构性异常。应重点排除心律失常和急性冠状动脉综合征。
