10 steps before you refer for syncope

Br J Cardiol 2010;17:28-31 Leave a comment
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Syncope, a transient loss of consciousness, can present to the clinician in a variety of ways. The most important tool for the clinician is the history, not only from the patient but also from a witness of the collapse, if available. Clinicians should be aware of the possibility that a patient or carer may unwittingly lead him or her in the wrong direction in attempting to describe falls or fits.

Misdiagnosis of epilepsy in the syncopal patient is well recognised. Data brought before Parliament have indicated at least 74,000 cases of misdiagnosis of epilepsy in England alone, at a cost of £184 million to the National Health Service (NHS), and incalculable cost to patients. The All-Party Report from 2007 only refers to patients misdiagnosed and mistreated with anticonvulsants, there are many more patients in whom epilepsy is ‘equivocal’, but who often have to bear the stigma of diagnosis.

In discussions about syncope, definitions are important. Syncope is a sudden, brief loss of consciousness due to a reduction in blood flow to the brain and, thus, of its oxygenation. With loss of consciousness there is collapse that may or may not be associated with jerking of the limbs. This can lead to confusion in the separation of epilepsy from syncope and we know that approximately 10% of patients diagnosed as having epilepsy probably suffer from syncope.

Syncope is a frightening symptom, which renders the sufferer, and those who are close, concerned about the diagnosis. In particular they will be worried about continuing the activities of normal life without social isolation due to the embarrassment and stigma of collapsing in public. Throughout the clinical pathway keeping the patient central to the process and supported remains vital. Support for both the patient and the professional can be sought at www.stars.org.uk

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