Adult Syncope

Question 1

What is consider low risk syncope?

Answer 1

• Reflex Syncope
  OR
• Uncomplicated orthostatic hypotension

Question 2

What is the Mx for low risk Syncope?

Answer 2

• Symptom relief if required
• VVED referral for potential community management

Question 3

What is considered High-risk Syncope?

Answer 3

• Absence of symptoms prior to collapse
• Associated with palpitations
• Cardiac Device (pacemaker or implanted cardioverter defibrilator)
• Chest pain
• Exertional onset or occurs when supine
• Family Hx of young sudden cardiac death <50years
• Ischaemic or structural heart disease
• Persistent hypotension (SBP < 90)
• Abnormal ECG (Bradycardia, Pre-excited QRS, 2nd/3rd degree heart block, SVT or Paroxysmal Atrial Fibrilation)

Question 4

What is the Mx for High-risk Syncope?

Answer 4

• Tx
• Mx as per appropriate CPG

Question 5

What are the care objectives for adult syncope?

Answer 5

• Identify patients suffering from syncope
• Symptomatic management if required
• Identify care pathway appropriate to patients condition and risk profile

Question 6

What is the definition of syncope?

Answer 6

• Transient loss of consciousness due to cerebral hypoperfusion, with defining characteristics (Rapid onset, short duration and spontaneous complete recovery)

Question 7

What are some characteristics of reflex syncope?

Answer 7

• Hx of recurrent syncope before age 40
• Preceded by unpleasant sight, sound, smell, or pain
• Prolonged standing
• During meal
• Being in crowded and/or hot place
• Autonomic symptoms prior to collapse (pallor, sweating, nausea/vomiting)
• With head rotation or pressure on carotid sinus (Tight collars, shaving)
• Absence of pre-existing heart disease

Question 8

What are some characteristics or orthostatic hypotension

Answer 8

• While, or immediately following, standing
• prolonged stnading
• standing following exertion
• hypotension following a meal
• Initiation or modification or vasodepressive medications or diuretics
• Presence of autonomic neuropathy or parkinsonism

Question 9

What are some characteristics associated with cardiovascular syncope?

Answer 9

• During exertion or when supine
• Sudden onset palpitations immediately followed by collapse
• familial history of unexplained death at young age
• Structural heart or coronary artery disease
• Concerning ECG findings