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‘Patients with suspected syncope should be investigated by cardiologists’

‘Patients with suspected syncope should be investigated by cardiologists’. Antagonist Maw Pin Tan Locum Consultant Physician Falls and Syncope Service Royal Victoria Infirmary Newcastle upon Tyne. http://www.nice.org.uk. Guideline Development Group. NICE guidelines for TLoC.

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‘Patients with suspected syncope should be investigated by cardiologists’

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  1. ‘Patients with suspected syncope should be investigated by cardiologists’ Antagonist Maw Pin Tan Locum Consultant Physician Falls and Syncope Service Royal Victoria Infirmary Newcastle upon Tyne

  2. http://www.nice.org.uk

  3. Guideline Development Group

  4. NICE guidelines for TLoC cardiovascular by the most appropriate local service • 1.2.3.1 Refer all people with TLoC (apart from the exceptions below) for a specialist cardiological assessment Exceptions are: • people with a firm diagnosis, after the initial assessment, of: • uncomplicated faint • situational syncope • orthostatic hypotension • people whose presentation is strongly suggestive of epileptic seizures.

  5. Points Syncope is a problem of older people Who is best skilled to conduct the assessments? Overlap between epilepsy and syncope Overlap between falls and syncope Most common cause– neurally-mediated syncope

  6. Incidence of Syncope Soteriades et al. NEJM 2002

  7. 1.3.1.1 Carry out a specialist cardiovascular assessment as follows. WHO? • Reassess the person’s: − detailed history of TLoC including any previous events − medical history and any family history of cardiac disease or an inherited cardiac condition − drug therapy at the time of TLoC and any subsequent changes. • Conduct a clinical examination, including full cardiovascular examination and, if clinically appropriate, measurement of lying and standing blood pressure. • Repeat 12-lead ECG and obtain and examine previous ECG recordings.

  8. Overlap between Epilepsy and Syncope • Zaidi et al JACC 2000 • Tinuper et al Brain 2001;124:2361-71 • Syncope presenting as epilepsy1 • 74 recurrent ‘seizure-like’ activity • 26% HUT+, 10% CSM+ • 42% alternative diagnosis • Epilepsy presenting as syncope2 • Ictal bradycardia

  9. Overlap between Falls & Syncope McIntosh et al. Age Ageing 1993 • Richardson et al PACE 1997 • Parry et al JAGS 2005 • Parry et al Heart 2005 • CSH • unexplained falls1 • Drop attacks2 • Amnesia for LOC3

  10. Causes of Syncope Parry & Tan BMJ 2010

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