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The San Francisco Syncope Rule is designed to assess the likelihood of a serious outcome following a syncope event, based on the presence of certain clinical factors. This rule utilizes a decision-making process based on five specific inputs related to the patient's condition.

The inputs include:

1. History of congestive heart failure
2. Hematocrit < 30%
3. New changes on ECG or any non-sinus rhythm
4. Shortness of breath
5. Systolic blood pressure < 90 mmHg at triage

For each input, a binary condition is checked: if any one of these conditions is true (i.e., the patient meets any one of these criteria), then the result will indicate a likelihood of a serious outcome. Conversely, if none of these conditions are met, the result would indicate that a serious outcome is unlikely.

The computation process is as follows:

1. Check if the patient has a history of congestive heart failure.
2. Determine if the patient's hematocrit level is less than 30%.
3. Identify any new changes on the ECG or non-sinus rhythm.
4. Check for the presence of shortness of breath.
5. Verify if the patient's systolic blood pressure is less than 90 mmHg at triage.

If any of these conditions is true, the result returned is "Serious outcome is likely". If none of these conditions are true, the result is "Serious outcome is unlikely". 

The San Francisco Syncope Rule (SFSR) is a clinical prediction rule used to evaluate patients who present with syncope, or sudden temporary loss of consciousness. This rule is specifically designed for patients in the emergency department setting. The SFSR helps clinicians identify patients who are at risk of serious outcomes within 7 days of a syncope episode, such as death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing a return to the emergency department and hospitalization for related events. 

The rule uses five criteria, represented by the acronym CHESS: Congestive heart failure, Hematocrit less than 30%, abnormal Electrocardiogram (ECG), Shortness of breath, and systolic blood Pressure less than 90 mmHg. If any of these criteria are present, the patient is considered at high risk.

The SFSR should not be used in patients with obvious trauma, seizure, or a clear non-cardiac cause of syncope, as well as in patients with persistent altered mental status or who are not back to their neurological baseline.

San Francisco syncope rule for prediction of serious outcomes

The Canadian Syncope Risk Score calculator is designed to assess the likelihood of serious adverse events following an episode of syncope, based on information derived from three areas: clinical evaluation, investigations, and diagnosis in the emergency department.

For the clinical evaluation, the factors contributing to the score include:
- A predisposition to vasovagal symptoms, such as those triggered by a warm crowded place, prolonged standing, or emotional responses, adds 1 point.
- A history of heart disease, including coronary or valvular heart disease, cardiomyopathy, congestive heart failure, or non-sinus rhythm, also adds 1 point.
- Any systolic blood pressure reading below 90 mmHg or above 180 mmHg contributes 2 points.

Regarding investigations:
- An elevated troponin level, exceeding the 99th percentile of the normal population, adds 2 points.
- An abnormal QRS axis (less than -30 degrees or more than 100 degrees) contributes 1 point.
- A QRS duration greater than 130 milliseconds adds 1 point.
- A corrected QT interval extending beyond 480 milliseconds adds 2 points.

Lastly, for the diagnosis made in the emergency department:
- Both vasovagal syncope and cardiac syncope contribute 2 points each to the total score.

Once these individual scores are tabulated, they are summed to arrive at a total score. Based on this score, the calculator offers a risk interpretation, ranging from low to very high:

| Score | Interpretation                                                | Estimated Risk of Serious Adverse Events |
|-------|---------------------------------------------------------------|------------------------------------------|
| -3    | Very low risk                                                 | 0.4%                                     |
| -2    | Very low risk                                                 | 0.7%                                     |
| -1    | Low risk                                                      | 1.2%                                     |
| 0     | Low risk                                                      | 1.9%                                     |
| 1     | Medium risk                                                   | 3.1%                                     |
| 2     | Medium risk                                                   | 5.1%                                     |
| 3     | Medium risk                                                   | 8.1%                                     |
| 4     | High risk                                                     | 12.9%                                    |
| 5     | High risk                                                     | 19.7%                                    |
| 6     | Very high risk                                                | 28.9%                                    |
| 7     | Very high risk                                                | 40.3%                                    |
| 8     | Very high risk                                                | 52.8%                                    |
| 9     | Very high risk                                                | 65.0%                                    |
| 10    | Very high risk                                                | 75.5%                                    |
| 11    | Very high risk                                                | 83.6%                                    |

This interpretation helps gauge the patient's risk level for serious adverse events post-syncope, guiding clinical decision-making and potential management strategies.

The Canadian Syncope Risk Score (CSRS) is a clinical calculator used in the assessment of adult patients who present with syncope, a temporary loss of consciousness usually related to insufficient blood flow to the brain. The CSRS is designed to predict the short-term risk of serious adverse events, such as arrhythmias, myocardial infarction, or death, within 30 days of a syncope episode. This tool aids clinicians in making decisions about hospital admission, further diagnostic testing, and patient management. The CSRS should not be used in patients with obvious causes of loss of consciousness such as seizure or stroke, or in patients with a known diagnosis that readily explains the syncope.

Canadian syncope risk score

The OESIL score for syncope helps assess the risk of 12-month all-cause mortality in individuals who experience syncope. This risk stratification tool evaluates four key factors related to the patient’s clinical profile.

The computation involves checking whether each of the following conditions applies:

- Age is greater than 65 years
- History of cardiovascular disease
- Syncope occurred without any warning (prodrome)
- ECG shows abnormalities

Each condition that is present contributes a score of 1 to the total OESIL score. Therefore, the total score ranges from 0 to 4, with each point increasing the level of risk. This straightforward scoring system translates the presence of clinical risk factors into a numerical value. Here’s how the score is interpreted:

- A score of **0** means the risk of 12-month all-cause mortality is **0%**.
- A score of **1** indicates a **0.8%** risk.
- A score of **2** suggests a **19.6%** risk.
- A score of **3** corresponds to a **34.7%** risk.
- A score of **4** represents a **57.1%** risk.

By translating clinical observations into these structured scores, clinicians can better understand and communicate the potential severity of a syncope incident, thereby guiding informed decision-making for further management.

The OESIL (Osservatorio Epidemiologico sulla Sincope nel Lazio) score for syncope is a clinical calculator used to predict the one-year risk of mortality in patients who present with syncope, a sudden, brief loss of consciousness followed by spontaneous recovery. This scoring system is particularly useful in the emergency department setting to stratify patients based on their risk and guide further management. The OESIL score takes into account factors such as age, cardiovascular history, abnormal ECG findings, and the nature of the syncope episode. It does not have specific exclusion criteria, but it should be noted that it is less accurate in predicting short-term outcomes and is not designed to identify the underlying cause of syncope.

OESIL score for syncope

The Evaluation of Guidelines in Syncope Study (EGSYS) score is a tool designed to assess the likelihood that a person's syncope (fainting episode) is cardiac in origin. It uses six specific questions related to symptoms or scenarios at the onset of syncope. Based on the responses, numerical scores are assigned and summed to provide an overall score.

Here's how scoring works:

- **Palpitations before syncope**
  - Yes: 4 points
  - No: 0 points
- **Abnormal ECG or heart disease**
  - Yes: 3 points
  - No: 0 points
- **Syncope during effort**
  - Yes: 3 points
  - No: 0 points
- **Syncope in a supine position**
  - Yes: 2 points
  - No: 0 points
- **Autonomic prodromes (nausea/vomiting)**
  - Yes: 1 point
  - No: 0 points
- **Predisposing and/or precipitating factors (warm or crowded place, prolonged orthostasis, fear/pain/other emotion)**
  - Yes: 1 point
  - No: 0 points

Each "Yes" answer contributes to a higher total score, with points culminating to a range between 0 and 14. This score informs the likelihood of the syncope being cardiac-related:

- **Score 3 or more**: Cardiac syncope is likely.
- **Score 2 or less**: Cardiac syncope is unlikely.

This assessment helps guide healthcare providers by evaluating the potential cardiac origin of syncope based on a structured score.

The Evaluation of Guidelines in Syncope Study score, commonly referred to as the EGSYS score, is a clinical calculator used in the assessment of patients presenting with syncope, a temporary loss of consciousness usually related to insufficient blood flow to the brain. This scoring system is designed to help clinicians differentiate between cardiac and non-cardiac causes of syncope, which is crucial as cardiac syncope carries a higher risk of mortality and morbidity.

The EGSYS score applies to adult patients who present with syncope. It includes factors such as abnormal ECG, palpitations preceding syncope, syncope during effort or in supine position, and autonomic prodromes. Each factor is assigned a certain number of points, and the total score is used to estimate the likelihood of a cardiac cause.

The EGSYS score should not be used in patients with obvious non-cardiac causes of syncope, such as those with a clear history of vasovagal syncope (e.g., syncope triggered by pain or fear), or in patients with a known non-cardiac neurological condition that could cause syncope (e.g., seizures). It should also not be used in isolation but in conjunction with a comprehensive clinical assessment.

Evaluation of Guidelines in Syncope Study score (EGSYS score)

The calculator categorizes the severity of heart failure using the New York Heart Association (NYHA) functional classification system. It does this by analyzing a patient's reported physical abilities related to cardiac disease and matches them to one of the four NYHA classes.

Here's the breakdown of each class:

- Class I involves patients who have cardiac disease but do not experience any limitations in physical activity. Regular activities do not cause undue fatigue, palpitation, or shortness of breath.
  
- Class II fits patients who have a slight limitation in physical activity due to cardiac disease. They feel comfortable when at rest, but ordinary physical activities might lead to fatigue, palpitation, or breathlessness.
  
- Class III describes patients with a marked limitation in physical activity. These individuals are comfortable when resting, but even less than ordinary activities cause fatigue, palpitations, breathlessness, or chest pain.
  
- Class IV covers patients who cannot engage in any physical activity without experiencing discomfort. They exhibit symptoms of heart failure even when at rest, and any physical activity worsens these symptoms.

To determine the appropriate class for a patient, the calculator compares the user’s description of their physical ability with these four established patterns. Each condition is linked specifically to one of the NYHA classes, providing a clear pathway from symptom description to classification. For example, if a patient’s physical condition matches the criteria for Class I, then the result is "Class I." This comparison method efficiently identifies the level of heart failure severity based on self-reported abilities and symptoms.

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

Sick sinus syndrome

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