Syncope

Question 1

What is syncope?

Answer 1

Temporary loss of consciousness due to a disruption of blood flow to the brain

Question 2

What are other terms for a syncopal episode?

Answer 2

Vasovagal episodes

Fainting.

Question 3

What is the term used to refer to the way people felt prior to fainting?

Answer 3

Prodrome

Question 4

What are the prodromal symptoms?

Answer 4

• Hot or clammy
• Sweaty
• Heavy
• Dizzy or lightheaded
• Vision going blurry or dark
• Headache

Question 5

How can the causes of syncope be divided?

Answer 5

Into Primary and Secondary

Question 6

What are the primary causes of syncope?

Answer 6

• Dehydration
• Missed meals
• Extended standing in a warm environment- school assembly
• A vasovagal response to a stimuli, such as sudden surprise, pain or blood

Question 7

What are the secondary causes of syncope?

Answer 7

• Hypoglycaemia
• Dehydration
• Anaemia
• Infection
• Anaphylaxis
• Arrhythmias
• Valvular heart disease
• Hypertrophic obstructive cardiomyopathy

Question 8

What are the possible cardiac causes of syncope?

Answer 8

• Arrhythmias
• Valvular heart disease
• Hypertrophic obstructive cardiomyopathy

Question 9

What can occur during a syncopal episode that can cause confusion with a seizure?

Answer 9

Twitching, shaking or convulsion activity

Question 10

What do you need to look for in a history of someone who has a syncopal episode?

Answer 10

• After exercise?
• Triggers?
• Concurrent illness?
• Injury secondary to the faint? Do they have a head injury?
• Associated cardiac symptoms, such as palpitations or chest pain?
• Associated neurological symptoms?
• Seizure activity?
• Family history, particularly cardiac problems or sudden death?

Question 11

What are the features of a syncopal episode prior to the event?

Answer 11

Prolonged upright position before the event
Lightheaded before the event
Sweating before the event
Blurring or clouding of vision before the event

Question 12

What happens to the body during a syncopal episode?

Answer 12

Reduced tone during the episode

Question 13

Is there a prolonged post ictal period after a syncopal episode?

Answer 13

No

Question 14

What should be done when someone presents syncopal episode?

Answer 14

Thorough examination

Question 15

What do you need to check in someone who has just had a syncopal episode?

Answer 15

Check for:
• physical injuries as a result of the faint, for example a head injury?
• Is there a concurrent illness, for example an infection or gastroenteritis?
• Neurological examination
• Cardiac examination, specifically assessing pulses, heart rate, rhythm and murmurs
• Lying and standing blood pressure

Question 16

What imaging can you do in someone after they have had a syncopal episode?

Answer 16

ECG

Question 17

What would you check for in an ECG of someone who has just had a syncopal episode?

Answer 17

Arrhythmia 
The QT interval for long QT syndrome
Paroxysmal arrhythmias (24 ECG)

Question 18

When might you do an echocardiogram in someone who has had a syncopal episode?

Answer 18

If there might be a structural heart disease

Question 19

What might you check for in the blood of someone who is presenting with a syncopal episode?

Answer 19

Full blood count: Anaemia
Electrolytes: arrhythmias and seizures
Blood glucose: diabetes

Question 20

Who is fainting common in?

Answer 20

Children- especially young girls

Question 21

What happens as a child who faints gets older?

Answer 21

They grow out of it