SHM's Clinical Quick Talks-Syncope

Syncope
Pdf Summary
The document titled "Syncope," authored by Edwin Rosas, MD, FHM, focuses on the management and diagnosis of syncope, which is a transient loss of consciousness (TLOC) due to temporary brain hypoperfusion. The guide is structured around key learning points which include differentiating syncope from other forms of TLOC, distinguishing between low-risk and high-risk syncope, and explaining a diagnostic approach to syncope.<br /><br />The initial diagnostic approach for syncope involves a thorough medical history, physical examination, and an ECG. The first step is distinguishing true syncope from mimickers such as epileptic seizures, subarachnoid hemorrhage (SAH), vertebrobasilar or carotid transient ischemic attack (TIA), subclavian steal syndrome, intoxication, metabolic disorders, and psychogenic pseudosyncope. These conditions have distinct characteristics that differentiate them from syncope, such as duration and accompanying symptoms.<br /><br />The second step involves identifying the type of syncope: Reflex syncope is triggered by stimuli or conditions like prolonged standing or large meals and is considered low-risk; Orthostatic Hypotension Syncope results from issues like hypovolemia or autonomic dysfunction, with risk varying by the condition; Cardiac Syncope has a sudden onset with high-risk indicators like exertion-related incidents and family history of sudden death.<br /><br />In the presence of known or suspected cardiovascular disease, following the 4 Ps framework (Plumbing, Pumping, Power, Ports) can help assess risk levels. High-risk syncope cases necessitate further targeted investigations.<br /><br />Clinical pearls suggest avoiding unnecessary imaging unless specific conditions are indicated, emphasizing efficient resource use. The guide is recommended for healthcare professionals when evaluating syncope, supported by high-value resources from recent guidelines. The document has been updated as of June 2025.
Keywords
Syncope
Transient Loss of Consciousness
Brain Hypoperfusion
Diagnosis
Risk Assessment
Reflex Syncope
Orthostatic Hypotension
Cardiac Syncope
ECG
4 Ps Framework