Determining the causes of syncopal ...

Determining the causes of syncopal episodes can be difficult. orders that would distinguish between cardiac, reflex-mediated, neurogenic, and idiopathic etiologies would be helpful. Brain natriuretic peptide plasma concentrations are being used widely to identify patients with myocardial dysfunction.

Tanimoto and associates measured brain natriuretic peptide flats on the morning after admission in 118 adult patients who were admitted to the hospital for fainting fit The cause of syncope was determined using a diagnostic algorithm hinted by the American College of Physicians. Patients were classified into common of four etiologic categories; a majority (52 percent) had cardiac etiologies for the syncopal episode. The cause of swoon was unknown in 25 percent of the patients.

Brain natriuretic peptide was significantly higher in the cardiac assemblage (118 [+ or -] 42 pg through mL) than in the other assemblages The highest levels occurred in patients with organic cardiac disease, followed by dint of those with tachycardia and then according to those with bradycardia. Using a cutoff of 40 pg by mL, the sensitivity and specificity of brain natriuretic peptide flushs in identifying cardiac syncope were 82 and 92 percent respectively.

The authors gather that cardiac causes for elision are much more likely in patients with a brain natriuretic peptide of the same height greater than 40 pg for mL. Electrocardiography and echocardiography are helpful in identifying specific cardiac causes. Because one patients in the unknown-cause dispose had elevated levels of brain natriuretic peptide, it is likely that these patients had cardiac fainting but that the specific cardiac disorder was not identified.

Tanimoto K et al. Usefulness of brain natriuretic peptide as a marker for separating cardiac and noncardiac causes of fainting fit Am J Cardiol January 15 2004;93:228-30

COPYRIGHT 2004 American Academy of Family Physicians

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