Medical history (history of illness) represents an important component in the diagnosis of syncope or collapse. Family History Has there been a death of a family member younger than 30 years of age? Sudden cardiac death in the family? Social history Is there any evidence of psychosocial stress or strain due to your family situation? … Syncope and Collapse: Medical History
General Measures [ESC Syncope Guidelines 2018 + S1 Guideline 2020] Immediately call 911! (Call 112) Clarification: Is it syncope or are there other reasons for the circulatory collapse? Is there a risk that the patient could suffer a cardiovascular event or die? The following questions should be asked by the clinician when evaluating fainting in … Syncope and Collapse: Therapy
Cardiac – affecting the heart – causes Cardiovascular (I00-I99). Adams-Stokes seizure – syncope (brief loss of consciousness) due to brief asystole (cessation of electrical and mechanical cardiac action for more than 2 seconds) as a result of sinus node arrest, SA block, or AV block [patient looks dead and has prominent facial flushing on recovery] … Syncope and Collapse: Or something else? Differential Diagnosis
A comprehensive clinical examination is the basis for selecting further diagnostic steps: Assessment of consciousness using the Glasgow Coma Scale (GCS). General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes [signs of injury due to a possible fall event?, signs of dehydration (dehydration)?] Signs of right … Syncope and Collapse: Examination
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Small blood count Inflammatory parameters – CRP (C-reactive protein) or ESR (blood sedimentation rate). Sodium – exclusion of hyponatremia (sodium deficiency). Fasting glucose (fasting blood glucose) – exclusion of hypoglycemia (hypoglycemia). Highly … Syncope and Collapse: Test and Diagnosis
Therapeutic Targets Avoidance of recurrence (recurrence) of syncope. Avoidance of secondary complications (e.g., risk of falling). Drug recommendations [S1 Guideline 2020] Patients with reflex syncope (neurogenic orthostatic hypotension/orthostatic hypotension): Medication in young patients with hypotension: Midodrine (alpha-1 receptor antagonist; sympathomimetic/support of peripheral vasoconstriction; midodrine is a prodrug whose metabolite desglymidodrine is the actual active ingredient) … Syncope and Collapse: Drug Therapy
Obligatory medical device diagnostics. Vital signs including temperature, oxygen saturation, and respiratory rate. Repeated blood pressure measurement* on both arms with cuff adjusted to arm circumference. Electrocardiogram* (ECG; recording of the electrical activities of the heart muscle; here: 12-lead ECG) – for basic diagnosis or when arrhythmogenic syncope (due to cardiac arrhythmia) and/or structural cardiac … Syncope and Collapse: Diagnostic Tests
The following symptoms and complaints may indicate syncope: Leading symptom Short-term loss of consciousness with/without falling down. Note: typical triggers, prodromes (uncharacteristic precursors or even early symptoms of a disease), brief reorientation Canadian syncope risk score Factors Points Predisposition to vasovagal symptoms* . -1 Known heart disease* * 1 Any systolic value < 90 or … Syncope and Collapse: Symptoms, Complaints, Signs
