Print bookPrint book

Syncope toolkit

Site: Royal College of General Practitioners - Online Learning Environment
Course: Syncope Hub
Book: Syncope toolkit
Printed by: Guest user
Date: Wednesday, 26 March 2025, 8:16 AM

Description

This toolkit will guide the GP through the initial assessment, appropriate investigation and management of patients with syncope.

Table of contents

Resources


PoTS UK

Charity for those with postural tachycardia syndrome. Website has a list of clinicians with an interest in this area as well as information for patients and healthcare professionals. The first link is to a GP summary of PoTS and the second is to a page of talk recordings, for those who want to know more.


Syncope Trust And Reflex Anoxic Seizures (STARS)

The website of this charity has information on a variety of causes of syncope, as well as patient information about travel insurance companies which are likely to cover those with syncope, and a list of specialists with an interest.


Stop Fainting

This website is run by staff who treat syncope at Imperial College Healthcare Trust. It has information about the causes of syncope, what investigations might be done, and about conservative and medical management.


Patient information on reflex anoxic seizures

Though benign, this condition can be terrifying for patients. The following information leaflets may be useful.


Cardiac Risk in the Young (CRY)

This UK based charity offers bereavement support after the sudden cardiac death of a person aged 35 or under – this may have presented with cardiac syncope. They also offer support to young people diagnosed with cardiac conditions, and screening with ECGs and echocardiograms. Their website has information for GPs and patients.


Resources for athletes

Athletes who seek advice from their GP regarding sport and syncope or risk of heart disease may find the following resources useful. The first article concerns return to sport after COVID-19 infection and has a pragmatic flowchart to follow and the second would help them to access cardiac screening (if aged under 35). GPs are generally not trained or indemnified to certify someone as fit to return to sport; if such a report is needed then the patient could be directed to a private sports medicine physician.


Patient information on arrhythmias

Patients with a cardiac cause for their syncope may find the following resources useful.


Information on drugs which alter the QT interval

This information classifies drugs into those with a known risk of torsade de pointes (TdP) due to prolonged QT interval, those with a possible risk of TdP, and those which may cause TdP in certain situations. Registration is required and is free. 


Information on syncope units

The following articles may be useful for commissioning GPs who are thinking about commissioning a syncope unit.

  • Kenny RA, Brignole M, Dan GA, et al. Syncope Unit: rationale and requirement – the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society. EP Europace 2015 Sep;17(9):1325–1340.
  • McLintock B, Reid J, Capek E, et al. Unscheduled care bed days can be reduced with a syncope pathway and rapid access syncope clinic. Br J Cardiol 2019 Nov;26:133–6.
  • Adlan AM, Eftekhari H, Paul G, et al. The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center. J Arrhythm. 2020 Aug 31;36(5):854-862. 


References

  • Adamson DL, Nelson-Piercy C. Managing palpitations and arrhythmias during pregnancy. Heart. 2007 Dec;93(12):1630-6. 
  • Adlan AM, Eftekhari H, Paul G et al. The Impact of a Nurse-Led Syncope Clinic: Experience from a single UK tertiary center. J Arrhythm. 2020 Aug 31;36(5):854-862. 
  • Alpert JS. Syncope in the Elderly. Am J Med. 2019 Oct;132(10):1115-1116.
  • Benbadis SR, Chichkova R. Psychogenic pseudosyncope: an underestimated and provable diagnosis. Epilepsy Behav. 2006 Aug;9(1):106-10.
  • Bergau L, Sohns C, Sommer P. Unexplained syncope in a young athlete: the diagnostic process to find the diagnosis-a case report. Eur Heart J Case Rep. 2022 Jan 31;6(1):ytac018.
  • Bhatia M, Kavi L, Nelson‐Piercy C. Postural tachycardia syndrome and pregnancy. The Obstetrician & Gynaecologist 2018;20: 119-123.
  • Blad H, Lamberts RJ, van Dijk GJ et al. Tilt-induced vasovagal syncope and psychogenic pseudosyncope: Overlapping clinical entities. Neurology. 2015 Dec 8;85(23):2006-10.
  • Brignole M, Moya A, de Lange FJ et al. ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018 Jun 1;39(21):1883-1948. 
  • Dhutia H, Sharma S. Cardiovascular screening of young athletes with electrocardiography in the UK: at what cost? Br J Cardiol 2017; 24: (1).
  • DVLA. Assessing fitness to drive: a guide for medical professionals. Feb 2024. [accessed 21 May 2024]. 
  • Goliasch G, Kammerlander AA, Nitsche C et al. Syncope: The Underestimated Threat in Severe Aortic Stenosis. JACC Cardiovasc Imaging. 2019 Feb;12(2):225-232.
  • Grossman SA, Badireddy M. Syncope. 2023 Jun 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 
  • Hajduczok AG, Ruge M, Emery MS. Risk Factors for Sudden Death in Athletes, Is There a Role for Screening? Curr Cardiovasc Risk Rep. 2022;16(10):97-109.
  • Hansen BL, Jacobsen EM, Kjerrumgaard A et al. Diagnostic yield in victims of sudden cardiac death and their relatives. Europace. 2020 Jun 1;22(6):964-971.
  • Hughes DC, Orchard JW, Partridge EM et al. Return to exercise post-COVID-19 infection: A pragmatic approach in mid-2022. J Sci Med Sport. 2022 Jul;25(7):544-547.
  • Joglar JA, Kapa S, Saarel EV et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm. 2023 Oct;20(10):e175-e264.
  • Kavi L. Postural tachycardia syndrome and long COVID: an update. Br J Gen Pract. 2021 Dec 31;72(714):8-9.
  • Kavi L. Transient loss of consciousness (TLoC) in primary care: a review of patients presenting with first blackout. Br J Cardiol 2017;24:62-5.
  • Kavi L, Nuttal M, Low D et al. A profile of patients with postural tachycardia syndrome and their experience of healthcare in the UK. Br J Cardiol 2016;23:33.
  • Kenny RA, Brignole M, Dan GA et al. Syncope Unit: rationale and requirement--the European Heart Rhythm Association position statement endorsed by the Heart Rhythm Society. Europace. 2015 Sep;17(9):1325-40. 
  • Krywko DM, King KC. Aortocaval Compression Syndrome. 2023 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.
  • Kuiper A, van Egmond ME, Harms MP et al. Clinical Pearls - how my patients taught me: The fainting lark symptom. J Clin Mov Disord. 2016 Nov 2;3:16. 
  • Malhotra A, Dhutia H, Finocchiaro G et al. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med. 2018 Aug 9;379(6):524-534.
  • McLintock B, Reid J, Capek E et al. Unscheduled care bed days can be reduced with a syncope pathway and rapid access syncope clinic. Br J Cardiol 2019;26:133–6.
  • Miller AJ, Raj SR. Pharmacotherapy for postural tachycardia syndrome. Auton Neurosci. 2018 Dec;215:28-36. 
  • Mital R, Henry K. Abstract 11318: A Rare Case of Stretch Syncope of Adolescence Masquerading as Carotid Artery Dissection and Carotid Sinus Syndrome. Circulation 2022; 146: A11318.
  • Mizrachi EM, Sitammagari KK. Cardiac Syncope. 2023 Apr 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 
  • Ng J, Sheldon RS, Ritchie D et al. Reduced quality of life and greater psychological distress in vasovagal syncope patients compared to healthy individuals. Pacing Clin Electrophysiol 2019 Feb;42(2):180-188. 
  • NHS. Cardiomyopathy. May 2023. [accessed 21 May 2024].
  • NHS East Genomics. Sudden Cardiac Death (SCD). [accessed 21 May 2024].
  • NHSGGC Paediatrics for Health Professionals. Reflex Anoxic Seizures in Children: Advice for Referrers. [accessed 21 May 2024]. 
  • NICE CKS. Blackouts and syncope. Nov 2023. [accessed 21 May 2024]. 
  • NICE. CG109. Transient loss of consciousness ('blackouts') in over 16s. Nov 2023. [accessed 21 May 2024]. 
  • O'Dwyer C, Bennett K, Langan Y, Fan CW, Kenny RA. Amnesia for loss of consciousness is common in vasovagal syncope. Europace. 2011 Jul;13(7):1040-5. Electrophysiol. 2019 Feb;42(2):180-188.
  • Pabba K, Chakraborty RK. Jervell and Lange-Nielsen Syndrome. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.
  • Parry SW, Steen IN, Baptist M. Amnesia for loss of consciousness in carotid sinus syndrome: implications for presentation with falls. J Am Coll Cardiol. 2005 Jun 7;45(11):1840-3.
  • PoTS UK. GP Guide: PoTS on a Page. [accessed 21 May 2024].
  • Rathore G, Larsen P, Fernandez C et al. Diverse presentation of breath holding spells: two case reports with literature review. Case Rep Neurol Med. 2013;2013:603190.
  • Raj SR, Fedorowski A, Sheldon RS. Diagnosis and management of postural orthostatic tachycardia syndrome. CMAJ. 2022 Mar 14;194(10):E378-E385.
  • Raj SR, Guzman JC, Harvey P et al. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Can J Cardiol. 2020 Mar;36(3):357-372.
  • Saedon NI, Pin Tan M, Frith J. The Prevalence of Orthostatic Hypotension: A Systematic Review and Meta-Analysis. J Gerontol A Biol Sci Med Sci. 2020 Jan 1;75(1):117-122.
  • Tannemaat MR, Thijs RD, van Dijk JG. Managing psychogenic pseudosyncope: Facts and experiences. Cardiol J. 2014;21(6):658-64.
  • UK NSC Screening committee. Adult screening programme. Sudden cardiac death. 2019. [accessed 21 May 2024].
  • Wieling W. Observations of a syncope doctor during self-induced (near) syncope episodes. Clin Auton Res. 2021 Feb;31(1):43-45.
  • Zaidi A, Clough P, Cooper P et al. Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J Am Coll Cardiol. 2000 Jul;36(1):181-4. 

Date of publication: 29 November 2024