New at Hillel Yaffe: The Syncope Clinic

Fainting (syncope) is an extremely common medical problem, experienced by most people at least once or twice in their lives. Diagnosing the underlying cause, however, involves referrals to specialists in several fields of medicine, including neurology, cardiology, vascular medicine and ENT, something that can prove extremely bothersome for people suffering from fainting spells in addition to creating discomfort and delays in diagnosis and treatment. Last week, Hillel Yaffe Medical Center opened a unique clinic that brings all these specialties together under a single roof, enabling efficient and rapid diagnosis and treatment.

The Syncope Clinic is the brainchild of Dr. Yaron River, Head of the Neurology Department and Dr. Mark Kazatsker, Head of the Electrophysiology, Pacemakers & Arrhythmias Service. The clinic will accept patients who have the appropriate referrals from their family physician and the HMO funding commitment form (Form 17). 

About Fainting
Fainting (syncope) is one of the most common problems people experience. Fainting is a loss of consciousness attributed to a cessation of blood flow to the brain for several seconds. Statistics reveal that between 3%-5% of ER visits are due to fainting episodes. In Israel, 20,000 people suffer from chronic fainting, a number that grows by 10,000 patients every year. For approximately 400 of these patients who suffer repeated syncope, no underlying reason for the bouts is ever found, despite comprehensive testing.

Frequent fainting (syncope) is traumatic for both the patient and the patient's family, and could indicate a serious medical condition. The annual mortality rate for patients following a syncope episode is currently 7.5%, a number that reaches 33% when the cause is cardial. The recurrent morbidity rate is also significant, reaching 15%-33% of repeated injuries, 5%-7% of fractures and 1% as a result of traffic accidents. Recurrent fainting impairs the quality of life for patients: 73% of patients suffer from depression and diminished function, and 37% suffer from impaired ability to work. Sexual performance is negatively impacted in 30% of patients.

Identifying the cause of fainting can result in effective, specific treatment for most patients with a life-threatening condition.

An extremely common medical problem, one out of every two people will faint at some point in their lives for various reasons.

Diagnosis and Treatment
"After people faint," explained Dr. River, "they are sent for tests to diagnose the cause. For the most part, patients are referred to numerous specialists, beginning with the family physician (internal medicine), who then refers the patient to an ENT doctor, cardiologist, vascular specialist and, of course, a neurologist, until a diagnosis is obtained. This process is necessary, but the bureaucracy is lengthy, cumbersome and occasionally results in a delayed diagnosis, and subsequently delayed treatment."   

Dr. Kazatsker added, "In 2009, the European Society of Cardiology issued the first guidelines for special access that consolidated all of the diagnostic and treatment guidelines for fainting. The final diagnosis still requires all of the specialists mentioned. For this reason, we set up our clinic."  

Patients who arrive at the clinic complete a questionnaire about their medical history and current medical status. The nurse receiving the patient checks that the various tests, x-rays, etc. have been performed. The patient is then examined simultaneously by a neurologist and cardiologist. If necessary, a vascular specialist and ENT specialist are also called in to the room.

"For example," said Dr. Kazatsker, "if the suspected cause of the fainting is attributed to heart palpitations, we then implant a special subcutaneous device known as REVEAL, which monitors the heart rate, even remotely (i.e. when the person is at home) and allows for the detection of arrhythmia and subsequent treatment to prevent fainting."

In addition to the aforementioned, the clinic will explore the causes of disorders of the autonomic nervous system, which balances blood pressure and controls other functions, such as urination, sweating, digestive tract movement, etc.

The Syncope Clinic is located in the Neurology Institute facility. As previously mentioned, once they have their family physician's referral and Form 17 from their HMO, patients can make an appointment at the clinic.