Full Diagnostics for Sufferers of Syncope

By: Sarah Gooding
Tuesday, June 21, 2016

Any unexplained episode of losing consciousness should be evaluated by a specialist. Shilpa Kshatriya, MD, FACC, says the cause of such an episode could be syncope, the temporary loss of consciousness followed by almost immediate recovery.

Whether the cause is benign or points toward more serious underlying issues, Dr. Kshatriya and the staff at Heartland Cardiology in Wichita are prepared to walk patients through diagnostic and treatment options.

Syncope versus Seizure

Dr. Kshatriya says episodes of syncope will first be evaluated by primary care physicians, who will determine where to refer the patient for follow-up care.

“It’s often confusing for physicians to determine whether this is from seizures or syncope,” she says.

Symptoms of tongue bite, deja vu, confusion or seizure-like activity are suggestive of neurological origins.

However, sudden loss of consciousness while coughing, having blood drawn or standing is indicative of a syncope, and patients should be evaluated by a cardiologist.

Vasovagal or Neurocardiogenic Syncope

“Vasovagal or neurocardiogenic syncope is the most common type of syncope,” Dr. Kshatriya says. “Other causes of syncope can be more high-risk or have a worse prognosis and need cardiology evaluation.”

Dr. Kshatriya says Heartland is able to do a number of tests for syncope.

“A lot of times our patients are given heart monitors, and most patients receive an echocardiogram to rule out any sort of structural heart disease,” she says.

Syncope can be a symptom of bad valves or atrial tumors.

“These are the kinds of reasons for passing out that we can diagnose with these tests,” Dr. Kshatriya says. “In addition, we have some other types of tests we can utilize if the diagnosis is somewhat elusive. We can put in an implantable loop recorder , which is a really tiny device — smaller than a flash drive — implanted in the chest wall under local anesthesia. That can monitor heartbeat for slow and fast rhythms for two to three years. It’s very useful in someone if we were suspecting a cardiac reason for passing out.”

She says the head-up tilt test also provides helpful feedback. During the test, a patient is strapped to a table, elevated about 70 degrees, and monitored for all vital signs and possible episodes of syncope for 30–45 minutes.

“I have several patients who have elusive diagnoses who have been referred by their primary care physicians and have had diagnostic results by the loop recorder as well as the tilt-table test,” Dr. Kshatriya says.

Primary Care Role

Cardiologists can help get to the bottom of the cause of syncope, but they rely on their primary care colleagues to risk-prioritize patients.

Heartland Cardio Dr Kshatriya -article
Shilpa Kshatriya, MD, FACC

“A low-risk patient would be somebody who passes out when he or she has blood drawn, and that could be followed up on an outpatient basis,” Dr. Kshatriya says.

Other situations call for more urgent action, which Heartland is prepared to offer.

“When patients come in with symptoms — for example, passing out while lying down or driving — they should receive immediate evaluation,” Dr. Kshatriya says. “The other thing to be concerned about is if they have a family history of cardiac arrest or sudden cardiac death — that needs cardiac evaluation as well.”

She notes that abnormal EKGs or echocardiograms also call for immediate evaluation.

“We can usually work high-risk patients in within the same day or 24 hours,” Dr. Kshatriya says.

Heartland offers three locations throughout Wichita — on West Central, North Hillside and East 29th Street North — for patient convenience.

Treatment Options

Many episodes of syncope are one-time occurrences, but Dr. Kshatriya stresses the importance of follow-up evaluations regardless.

“There are a lot of different reasons for somebody to experience syncope,” she says. “It really depends. That’s why we need to find out why somebody had an episode of passing out.”

If a concern is found, Dr. Kshatriya says medications, pacemakers or lifestyle changes can be considered.

“We tell patients to have adequate fluid intake,” she says. “The biggest thing I see in older men and women is that they don’t drink enough fluid.”

Additionally, patients with syncope should avoid long, hot showers, as well as excessive alcohol and caffeine, and should refrain from standing in one place for a long period of time.

Appointments may be made with Dr. Kshatriya by calling Heartland Cardiology at 316-686-5300.