Get a Diagnosis: First Visit

1st Visits - Labs & Tests

An EKG (electrocardiogram) is recommended as a test that people with orthostatic problems should have to start out.

There are no specific lab studies or other studies/X-rays that should be done in every person who has symptoms of dizziness, weakness, fatigue, fainting. The tests that a person needs depends on their symptoms, what else is going on with their body and health and what the physician suspects might be causing a health problem.

Lab

There is no specific tests that are thought to have a high enough power to be absolutely indicated for the evaluation of syncope.⁷ Recommendations are based on the literature and consensus. Specific tests would be indicated based on the history and physical, e.g. tests for Addison's based on history and exam findings.

• Glucose - low yield but hypoglycemia found in 2 of 170 people with syncope. It's fast and easy.
• CBC- 4 - of 170 had signs and symptoms of GI hemorrhage with confirmation on CBC; signs or suggestion of anemia
• Serum electrolytes with renal function (sodium, potassium, creatinine, BUN) - have low yield unless evidence suggests endocrine disease, taking medications that impact electrolytes or there is altered mental status or suggestion of seizure activity or arrhythmia.
• Cardiac enzymes - if there is a history of chest pain with syncope, dyspnea with syncope or exertional syncope; those with multiple cardiac risk factors and those in whom cardiac origin is highly suspects.
• Urinalysis - A urinary tract infection (UTI) may set off or trigger syncope in the elderly. It can be asymptomatic.

Other Studies

There is no specific tests that are thought to have a high enough power to be absolutely indicated for the evaluation of syncope. Recommendations are based on the literature and consensus.

Specific tests would be indicated based on the history and physical. See Other tests - Cardiac and Other Tests-Neurologic for more information about the tests for conditions that cause orthostatic symptoms.

 

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References

1. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract.
2. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M et al., Guidelines for the diagnosis and management of syncope (version 2009). European Heart Journal (2009); 30: 2631-2671.
3. Brignole M. Diagnosis and Treatment of Syncope. Heart 2007: 93; 130-136. Article PDF
4. Stewart JM, Medow MS, Alejos JC. Orthostatic Intolerance. Medscape article.
5. Figueroa JJ, Basford JR, Low PA. Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleve Clin J Med. 2010 May;77(5):298-306.  Abstract.  Article PDF.
6. Freeman, Roy. Neurogenic orthostatic hypotension.NEJM 2008;358(6):615-624. Abstract