Role of Head and Cardiac Imaging, and Cardiac Stress Testing for Syncope

The most important step in evaluating a patient with syncope/collapse is detailed history and careful physical examination. The utility of head imaging in patients with syncope is low and carotid ultrasound (CUS), brain computed tomography (CT), and magnetic resonance image (MRI) should only be performed when there is a high suspicion for neurological disorders such as carotid stenosis, brain tumors, or parkinsonism. Similarly, echocardiography should be done only to confirm or refute suspected structural heart disease such as severe aortic stenosis, hypertrophic cardiomyopathies, or obstructive cardiac tumors. Finally, cardiac stress testing (i.e., using treadmill or stationary bike) should be performed if syncope occurs during or right after exercise.