Overview
Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion, followed by spontaneous recovery.
The clinical priority is distinguishing reflex and orthostatic causes from potentially life-threatening cardiac disease.
History
Ask about posture, prodromal symptoms, triggers, exertion, palpitations, family history of sudden cardiac death, medication use, and the circumstances surrounding the event.
Syncope during exertion or associated with palpitations is a major reason to investigate for cardiac disease.
Examination
Examination should include cardiovascular assessment, blood pressure, orthostatic measurements when appropriate, neurological assessment, and ECG.
Investigation
ECG is an important initial investigation. Further testing is guided by the history and examination and may include ambulatory rhythm monitoring or echocardiography.
Clinical Pearls
In syncope, the first question is “Could this be cardiac?” before assuming a benign explanation.
END OF REVIEW
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