Tips for taking the medical history in patients with syncope

Abstract

Transient loss of consciousness represents one of the most frequent reasons for patients to present in the emergency room. Already at the very beginning, the diagnostic work-up is faced with fundamental questions: (1)Was it really aloss of consciousness? (2)Which department (neurology, cardiology, or others) should check the patient? (3)Is an in-hospital diagnostic work-up required? These questions can be answered from ameticulous patient history which needs to be adjusted to the individual case but also has to systematically go through alist of questions. Patient history has to clarify whether syncope was present. Nonsyncopal events such as falls, transient global amnesia, epilepsy, psychogenic pseudosyncope, transient ischemic attack and drop attacks should be distinguished. In asecond step, the four groups of causes of syncope can be assessed. Neurocardiogenic reflex syncope usually occurs with typical prodromes in typical situations in (younger) patients without heart disease. Orthostasis always occurs in upright position, typically associated with standing up and in patients treated with antihypertensive drugs. Arrhythmogenic syncope frequently shows an abrupt onset without prodromes, associated with injury and with palpitations or fast heart beat before the attack, in older patients frequently associated with known heart disease, in young patients without heart disease frequently with afamily history positive for arrhythmias or sudden cardiac death. Apositive history of structural cardiovascular disease should be considered as acause of syncope, particularly if it occurs during exercise or in supine position, or is associated with chest pain or dyspnea. This review summarizes the most important questions that can elucidate the cause of syncope.