History of syncope (collapse)

Question 1

What are the causes of syncope?

Answer 1

Syncope is due to cerebral hypoperfusion causing the collapse.

Causes of this:

• neurally mediated
• vasovagal
• carotid sinus hypersensitivity
• situational: post micturition; post defecation
• orthostatic hypotension
• cardiogenic
• bradyarrythmia or tachyarrythmia
• structural
• aortic stenosis or hypertrophic cardiomyopathy

Question 2

What are the questions to ask?

Answer 2

• before, during, after

Before:

• what triggered the event (e.g vasovagal etc)
• did you have any symptoms before this
• any chest pain, palpitations
• did you feel faint or dizzy
• did you notice any change in the colour of your skin (systemic hypotension)

During:

• did anyone witness this and did they describe what happened
• did you lose consciousness and how long for
• did they notice any jerking of the limbs
• any tongue biting or sudden passage of urine

After:

• how long did you take to recover
• any episodes since then

-night sweats, fever, weight loss

PMH:

• has this happened before
• any known blood pressure problems or heart problems

DH:

• any known blood pressure lowering medication

etc.