Syncope

Question 1

what is the definition of syncope?

Answer 1

Syncope is a sudden and transient loss of consciousness that is associated with a loss of postural tone, and resolves spontaneously and completely without intervention.

Question 2

what is the aetiology of syncope?

Answer 2

Syncope is caused by the transient reduction in cerebral blood flow which results in hypoperfusion of both cerebral hemispheres simultaneously or sections of the brainstem thought to be responsible for the conscious state (the reticular activating system)
The causes of syncope are myriad and range from the benign to the life-threatening.
Physicians must identify patients with potentially life-threatening processes (e.g., dysrhythmias, pulmonary embolism, subarachnoid haemorrhage, acute coronary syndromes), patients who may require hospitalisation and intervention (e.g., patients with bradycardia or medication-induced orthostatic hypotension), and those with a more benign cause of syncope who can be discharged

Question 3

what are the red flag symptoms of syncope?

Answer 3

chest pain, palpitations, back pain, haematemesis, melena before the syncopal episode, and syncope with exercise

Question 4

what are the first line and gold standard investigations for syncope?

Answer 4

differentiate syncope from non-syncopal conditions, such as seizures, falls, psychogenic pseudosyncope, drop attacks, and transient ischaemic attacks
ECG
Blood pressure check in both arms on standing and 3 minutes of standing
Pulse rate and rhythm
Basic neurological exam

Question 5

what are the differential diagnoses for syncope?

Answer 5

Acute coronary syndrome
Ventricular arrhythmias
Anterior ventricular block