Syncope : Causes , Investigations , Management

 Syncope :

Syncope is a sudden and transient loss of consciousness which is followed by recovery.

Question to ask:

Will this patient need admission?

Will this patient require further investigations and Follow Up ?

Are there any underlying serious causes for the syncope and that need immediate Treatment

Causes :

These include the following :

Vaso vagal syncope :

This usually occurs in the young people and may be due to a number of factors.

Overwarm environment

Prolonged standing

Sudden fright or emotion

Prolonged Starvation

Large meals

Alcohol

Usually there are premonitory symptoms of feeling yn well , nauseated , dizzy or tired , with visual symptoms like visual blurring.

Relief may be obtained by telling the affectee to sit down or lie down with feet elevated.

Was it an epileptic seizure ?

Usually occurs rapidly and develops into generalized tonic clonic convulsions.

Frothing from the corner of the mouth , urinary incontinence and tongue biting may be present.

Post seizure confusion is common.

If a witness is present , it would be a good idea to get an account of the events from the witness.

Cardiac Causes:

Cardiac causes of syncope are also sudden in onset and are accompanied by pallor and sweating and may recover rapidly followed by flushing.

Associated palpitations may be present.

Ask about Chest pain and paliptations and cardiac medications like GTN / Glyceryl nitrare.

Some cardiac patients prone to syncope include

Paroxysmal AF / Atrial Fibrillation.

HOCM / Hypertrophic Obstructive Cardiomyopathy

Seizures / Epilepsy :

We need to exclude any epilepsy that might have caused the syncope.

Hypoglycemia :

Low blood sugars can lead to syncope as well.

Management:

If patient loses consciousness in A & E

Assess pulse

Attache Cardiac Monitor and Oximeter

Clear airway

Give oxygen to maintain levels more than 90 %

Do an ECG

Check BM Levels

Check blood pressure , Temperature.

Treat as per findings

Try to get a history of syncope from witnesses.

Examine the patient.

Look for any tongue biting or focal neurological signs.

Also examine the heart for murmur or any arrhythmias.

Do an ECG to look for arrhythmias or evidence of myocardial ischaemia

Lying standing BP should be checked.

Perform a chest X ray and look for lung fields and cardiac size.

Also check Urea and electrolytes, creatinine levels and any evidence of sepsis

Check Haemoglobin levels.

Check blood sugar levels

Send sepsis screen

Further management:

Patients with simple syncope may be discharged

Those with underlying causes / Seizures or cardiac causes shpuld be admitted and investigated further.