Genital Organs
Male Genital Organs
Female Genital Organs
Pregnancy, Postpartum Period, Infancy
Growth and Development
Eyes
Ears
Nose, Sense of Smell and Taste
Neurological Disorders
Voice, Speech, and Language Disorders
Pain
Psychological Disorders, Behavioral Disorders, Psychosocial Problems
Infectious and Parasitic Diseases
Neoplasms
Diseases of the Blood and Blood-Forming Organs
Endocrine, Nutritional, and Metabolic Diseases
Psychological and Behavioral Disorders
Diseases of the Nervous System
Diseases of the Eye and Adnexa
Diseases of the Ear and Mastoid Process
Diseases of the Circulatory System
Diseases of the Respiratory System
Diseases of the Digestive System
Diseases of the Skin and Subcutaneous Tissue
Diseases of the Musculoskeletal System and Connective Tissue
Diseases of the Genitourinary System
Pregnancy, Childbirth, and the Puerperium
Certain Conditions Originating in the Perinatal Period
Congenital Malformations, Deformations, and Chromosomal Abnormalities
Symptoms and Abnormal Clinical and Laboratory Findings
Injuries, Poisonings, and Certain Other Consequences of External Causes
Pathology
Pathophysiology
Clinical Chemistry
Medical Microbiology
Immunology
Hygiene
Medical Biometry/Statistics
Human Genetics
Medical History
Pharmacology
Acute Emergencies
Radiology
Surgery
Anesthesiology and Emergency Medicine
General Medicine
Naturopathy
History of Medicine
Occupational Medicine
Dental, Oral, and Maxillofacial Diseases

Syncope/Collapse

Definition

  • Syncope: Sudden, short-term, and spontaneously reversible loss of consciousness and tone due to cerebral hypoperfusion (approximately 10 seconds after the systolic perfusion pressure falls below 70 mmHg)
  • Collapse: Acute transient circulatory insufficiency due to reduced venous return to the heart, often accompanied by syncope

Medical History

Important diagnostic criteria:

  • Situation, position, and exercise dependence of syncope
  • Detailed description of the episode (patient’s or witness’s history)

Details to inquire:

  • Onset, timing, frequency, and duration of episodes
  • Depth of unconsciousness
  • Prodromes, aura
  • Circumstances surrounding the event
  • Known diseases (especially cardiac underlying conditions)
  • Medication use

TypeCause
VascularOrganic
– Organic vascular diseases
– Transient ischemic attack (TIA)
– Subclavian steal syndrome
Reflex
– Vasovagal
– Carotid sinus syndrome
– Pressor (micturition, defecation, coughing)
– Orthostatic dysregulation
CardiacArrhythmias
– Bradycardic (e.g., sinus node syndrome, AV block)
– Tachycardic (e.g., ventricular tachycardia, supraventricular tachycardia)
Cardiogenic-mechanical
– Heart failure
– Myocardial infarction
– Valve defects
– Pulmonary embolism
– Atrial myxoma
Cerebral– Epilepsy
– Eclampsia
– Narcolepsy
Endocrine– Hypoglycemia
Medication-induced– Antiarrhythmics (Class Ia, Ic, III)
– Tricyclic and tetracyclic antidepressants
– Antihistamines
– Cholinergic agonists
– Phenothiazines
– Neuroleptics
– Antibiotics, antifungals, antivirals

Symptoms

  • Sudden onset of brief loss of consciousness
  • Can occur abruptly (e.g., Adam-Stokes attack) or with warning signs:
  • Nausea
  • Headache
  • Visual disturbances
  • Pallor
  • Sweating
  • Slow and deep breathing

Physical Examination

  • Auscultation
  • Neurological examinations
  • Schellong test:
  • Measurement of pulse rate, blood pressure, and possibly QRS duration on ECG
  • At rest, under orthostatic stress, and after exercise

Diagnosis

Syncope can be a diagnostic challenge, as it may be a transient form of sudden cardiac death or simply “fainting.”

Laboratory tests:

  • Serum glucose: To exclude hypoglycemia