Important features suggesting cardiac origin of syncope

Syncope occurring a person with known heart disease increases the chance of it being of cardiac origin. This is more so in persons with history of obstructive valvular heart disease, pulmonary hypertension and tachyarrhythmias.

Abnormal physical findings on cardiovascular system like very fast or slow heart rate, cardiac murmurs suggesting obstructive valvular heart disease, left parasternal heave and loud pulmonary component of second heart sound are some which indicate a cardiac origin.

Family history of sudden death or drowning without another obvious cause may indicate familial arrhythmic disorders or cardiac ion channelopathies.

Age above 35 years has also been suggested to indicate cardiac origin as vasovagal syncope is likely to occur at younger age.

Two or fewer episodes may also indicate a cardiac origin. That is because recurrent syncope of relatively milder nature as not to need earlier medical attention may indicate vasovagal syncope and other relatively benign causes.

Palpitation preceding syncope would suggest a tachyarrhythmia as the cause. Valvular heart disease may also cause palpitation.

Chest pain or dyspnea associated with syncope definitely indicate more probability of cardiac origin of syncope.