Syncope physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Patients with syncope usually appear normal. Physical examination of patients with syncope is usually remarkable for cardiac murmur, orthostatic hypotension, and altered level of consciousness.

Physical Examination

Patients with syncope usually appear normal.

Physical examination of patients with syncope is usually remarkable for cardiac murmur, orthostatic hypotension, and altered level of consciousness.^[1]^[2]^[3]

Appearance of the Patient

Patients with Syncope usually appear normal.

Vital Signs

Tachycardia with regular pulse or (ir)regularly irregular pulse may be present in the case, structural heart disease is the underlying cause of syncope.
Bradycardia with regular pulse or (ir)regularly irregular pulse may be present in the case, conductive heart problems are the underlying cause of syncope.
Orthostatic hypotension may be present.

Skin

Skin examination of patients with syncope is usually normal. However, it may be remarkable for:

HEENT

HEENT examination of patients with syncope is usually normal.

Neck

Neck examination of patients with syncope is usually normal. However, it may be remarkable for the following findings depending on the underlying cause of syncope:

Jugular venous distension
Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope.
Hepatojugular reflux

Lungs

Pulmonary examination of patients with syncope is usually normal.

Heart

Cardiovascular examination of patients with syncope is usually normal. However, if the underlying cause of the syncope is cardiovascular disease, it may be remarkable for:^[2]

Heave / thrill
S3
S4
Gallops
A heart murmur may be heard using the stethoscope.

Abdomen

Abdominal examination of patients with syncope is usually normal.

Genitourinary

Genitourinary examination of patients with syncope is usually normal.

Neuromuscular

Neuromuscular examination of patients with syncope is usually normal. However, focal neurologic signs may be present if cerebrovascular events were misdiagnosed for syncope. These findings may include:^[3]

Altered mental status
Hyperreflexia
Positive (abnormal) Babinski
Muscle rigidity
Proximal/distal muscle weakness unilaterally/bilaterally
Unilateral/bilateral upper/lower extremity weakness
Dysdiadochokinesia (palm tapping test)
Opisthotonus and myoclonic jerks

Extremities

Extremities examination of patients with syncope is usually normal. It may be remarkable for the following findings depending on the underlying cause:

Clubbing
Cyanosis
Pitting/non-pitting edema of the upper/lower extremities

References

↑ Wieling, W.; Thijs, R. D.; van Dijk, N.; Wilde, A. A. M.; Benditt, D. G.; van Dijk, J. G. (2009). “Symptoms and signs of syncope: a review of the link between physiology and clinical clues”. Brain. 132 (10): 2630–2642. doi:10.1093/brain/awp179. ISSN 0006-8950.
↑ ^2.0 ^2.1 Sutton, Richard (2013). “Clinical Classification of Syncope”. Progress in Cardiovascular Diseases. 55 (4): 339–344. doi:10.1016/j.pcad.2012.11.005. ISSN 0033-0620.
↑ ^3.0 ^3.1 van Dijk, J. Gert; Wieling, Wouter (2013). “Pathophysiological Basis of Syncope and Neurological Conditions that Mimic Syncope”. Progress in Cardiovascular Diseases. 55 (4): 345–356. doi:10.1016/j.pcad.2012.10.016. ISSN 0033-0620.

[WielingThijs2009-1] Wieling, W.; Thijs, R. D.; van Dijk, N.; Wilde, A. A. M.; Benditt, D. G.; van Dijk, J. G. (2009). “Symptoms and signs of syncope: a review of the link between physiology and clinical clues”. Brain. 132 (10): 2630–2642. doi:10.1093/brain/awp179. ISSN 0006-8950.

[Sutton2013-2] 2.0 ^2.1 Sutton, Richard (2013). “Clinical Classification of Syncope”. Progress in Cardiovascular Diseases. 55 (4): 339–344. doi:10.1016/j.pcad.2012.11.005. ISSN 0033-0620.

[van_DijkWieling2013-3] 3.0 ^3.1 van Dijk, J. Gert; Wieling, Wouter (2013). “Pathophysiological Basis of Syncope and Neurological Conditions that Mimic Syncope”. Progress in Cardiovascular Diseases. 55 (4): 345–356. doi:10.1016/j.pcad.2012.10.016. ISSN 0033-0620.

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