Syncope

• What does syncope mean?


  A transient loss of consciousness
• What are the important differentials for syncope?


  Reflex syncope, orthostatic hypotension, and cardiac syncope
• What is commonly used to refer to a loss of consciousness?

  Blackouts
• Why is a thorough history important in cases of syncope?


  To help differentiate the causes of syncope
• What initial investigations are included in the assessment of syncope?


  An ECG, blood glucose, and a basic set of blood tests
• What is the purpose of emergency management in syncope cases?

  To rule out serious causes and treat any injuries
• What does the term "blackouts" refer to?


  Episodes of transient loss of consciousness
• What is the primary cause of syncope?

  Cerebral hypoperfusion
• What percentage of the population experiences blackouts at least once in their lifetime?

  50%
• What percentage of emergency department presentations in the UK are due to blackouts?


  3%
• What are some structural causes of cardiac syncope?


  Acute myocardial infarction, aortic stenosis, and cardiac tamponade
• What are some electrical causes of cardiac syncope?

  Tachyarrhythmias and bradyarrhythmias
• What is vasovagal syncope?


  A type of reflex syncope also known as "fainting"
• What is carotid sinus syndrome?


  Hypersensitivity of the carotid sinus baroreceptor
• What are some non-syncopal causes of blackouts?

  Seizures and psychogenic pseudosyncope
• What symptoms should be elicited when taking a history after a blackout?


  Triggers, prodromal symptoms, and associated symptoms
• How can exertional syncope be differentiated from vasovagal syncope?


  Exertional syncope occurs during exertion, while vasovagal syncope can occur due to pain or prolonged standing
• What does a duration of loss of consciousness of less than 30 seconds suggest?


  It suggests syncope
• What should be assessed during the examination of a patient after a blackout?


  A full set of observations including lying-standing blood pressure
• What does a fall in systolic blood pressure by 20 mmHg or more indicate?


  It indicates orthostatic hypotension
• What initial investigations should be carried out in the emergency setting for syncope?


  Blood glucose, ECG, and blood tests
• What is the purpose of a transthoracic echocardiography in syncope cases?


  To assess for suspected structural heart disease
• What should be done for patients with suspected epilepsy?


  They should be referred to a first fit clinic
• What should patients with unexplained syncope do regarding their driving license?


  Inform the DVLA and have their license revoked for 6 months
• What is the driving advice for patients with vasovagal syncope?


  Group 1 drivers need not inform the DVLA if they have a vasovagal episode while standing
• What should be done for patients with suspected cardiac syncope?


  They should be referred for specialist review within 24 hours
• What are the key components of the management of syncope?


  • Rule out serious causes
  • Treat any injuries sustained
  • Provide reassurance and advice for uncomplicated cases
  • Refer for specialist investigations as needed
  • Driving advice based on the type of syncope
• What are the symptoms and signs to elicit when assessing a patient after a blackout?

  • Triggers before the blackout
  • Prodromal symptoms
  • Associated symptoms
  • Protective measures during the blackout
  • Duration of loss of consciousness
  • Injuries sustained after the blackout
  • Confusion or amnesia post-episode
• What are the causes of syncope categorized into?


  • Cardiac syncope (structural and electrical causes)
  • Reflex syncope (vasovagal and situational)
  • Orthostatic hypotension
  • Other causes (e.g., pulmonary embolism, head trauma)
  • Non-syncopal causes (e.g., seizures, psychogenic causes)
• What are the important questions to ask during the history taking of a patient with syncope?


  • Activities or triggers before the blackout
  • Prodromal symptoms experienced
  • Intercurrent illnesses
  • Associated symptoms during the blackout
  • Previous similar events
  • Family history of cardiac issues
• What are the key investigations to perform in the emergency setting for syncope?


  • Blood glucose test
  • ECG for arrhythmias and structural abnormalities
  • Blood tests for electrolyte and inflammatory markers
  • Transthoracic echocardiography for structural heart disease
  • 24-hour ambulatory blood pressure monitoring
• What are the driving regulations for patients with syncope?


  • Unexplained syncope: inform DVLA, license revoked for 6 months
  • Vasovagal syncope while standing: Group 1 drivers need not inform DVLA
  • Cardiac syncope: must not drive and inform DVLA