Syncope

Question 1

What is neurally mediated syncope?

Answer 1

This is the ‘simple faint’ - it is a benign condition characterised by vasodilatation or vagally driven bradycardia

Question 2

Give some examples of neurally mediated syncope (VOSC)

Answer 2

• Vasovagal
• Orthostatic hypotension
• Situational
• Cardiac sinus syndrome

Question 3

How can neurally mediated syncope be managed?

Answer 3

Recognise prodrome
Sit/lie on floor
Muscle tensing exercises
Increase fluid intake
Compression stocking
Medication (fludrocortisone)

Question 4

What is orthostatic hypotension?

Answer 4

Symptomatic fall in systolic BP of 20mmHg or more or drop in diastolic BP of 100mmHg or more within 3 min of standing

Question 5

What investigations should be done in a person with syncope?

Answer 5

Bedside: Obs, ECG
Bloods: FBC
Imaging: Echo, CT head
Special: L/S BP, Tilt clinic, carotid-sinus massage

Question 6

Describe a typical history of neurogenic syncope

Answer 6

Situation
-Crowded place, hot, emotional, prolonged standing
Trigger
-Venepuncture, coughing, urination, neck pressure
Warning symptoms
-Light headed, hot, sweaty, nauseated, blurred vision, tinnitus
Aftermath
-Memory of waking where fell, back to normal very quickly
Witness
-Pale, limbs floppy, motionless or minor, intermittent jerking
Predisposition
-Young, female

Question 7

Describe a typical history of cardiac syncope

Answer 7

Situation
-Sitting or lying, exercise
Trigger
-Exercise
Warning
-None, light headed
Aftermath
-Memory of waking where fell, back to normal very quickly
Witness
-Pale, limbs floppy, motionless or minor, intermittent jerking
Presdisposition
-Cardiac symptoms, cardiovascular risk factors, abnormal ECG, family history of sudden unexplained death