Fast Five Quiz: Syncopal Events

Richard H. Sinert, DO


January 30, 2020

History and physical examination are the most specific and sensitive ways to evaluate syncope. A detailed account of the event must be obtained from the patient. The account must include the circumstances surrounding the episode: the precipitant factors, the activity the patient was involved with before the event, and the patient's position when it occurred. Precipitating factors can include fatigue; sleep or food deprivation; warm ambient environment; alcohol consumption; pain; and strong emotions, such as fear or apprehension.

Activity before syncope may give a clue as to the etiology of symptoms. Syncope may occur at rest; with change of posture; on exertion; after exertion; or with specific situations, such as shaving, coughing, voiding, or prolonged standing. Syncope occurring within 2 minutes of standing suggests orthostatic hypotension. Assess whether the patient was standing, sitting, or lying down when the syncope occurred. Syncope while seated or lying down is more likely to be cardiac.

Symptoms of nausea or diaphoresis before the event may suggest syncope rather than seizure when the episode was not witnessed, whereas an aura may suggest seizure. Postevent confusion is a powerful tool for discriminating between syncope and seizure. A postictal phase suggests that a seizure has occurred. Postevent confusion has been described with syncope, but the confusion typically lasts 30 seconds or less in most patients (non-elderly). Seizurelike activity can occur with syncope if the patient is held in an upright posture.

Read more about the presentation of syncope.


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