Syncope toolkit

Syncope is very common and will affect 42% of people during their lifetime

Initial assessment of the syncope patient

In this section:

History taking

Things to ask the patient (and preferably a witness)

Circumstances or triggers
  • Medical procedure
  • Stress, pain, fear
  • Ask about situational syncope, for example micturition, defaecation
  • Relationship to exercise
  • Relationship to meals or alcohol.
Posture Standing, sitting or lying flat
  • Sweating
  • Feeling hot
  • Palpitations
  • Chest pain
  • Breathlessness
  • Visual and hearing disturbances.
  • Eyes open or closed, pallor, sweating or cyanosis
  • Movement - limb jerking (brief irregular jerky limb movements are common in vasovagal syncope and may be misinterpreted as seizure-like. These movements commence within 10 seconds of loss of consciousness)
  • Tongue biting ā€“ typically tip in vasovagal, lateral tongue in epilepsy
  • Injury
  • Duration of episode
  • Unilateral weakness
  • Post-event confusion (more common and prolonged in epilepsy, but can be seen after severe vasovagal syncope).
History of syncope First event or number and frequency of previous episodes.
Past medical history
Family history Premature sudden cardiac death at age of under 40 years, inherited heart disease.

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Examination of patient

  • Cardiovascular examination
  • Neurological examination if indicated by the history
  • Other systems as appropriate
  • Active stand test.

Within a 10-minute consultation, it may be impossible to conduct all aspects of the assessment and it may be necessary, after risk assessment, to arrange a follow-up consultation.

Risk stratification tools

Risk stratification tools are of limited value and have not been shown to perform better than good clinical judgement in identifying patients at high risk of serious short-term outcomes. Most risk assessment tools were developed for use in the emergency department and no risk assessment tools have been validated in primary care.

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Syncope educational resources for healthcare professionals