Syncope
Red flags – Consider admission/urgent referral:
· Syncope during exertion/supine
· Syncope associated with unexplained chest pain, breathlessness or back pain
· Family history sudden death (<40years) or significant inheritable cardiac condition
· Known pacemaker/defibillator to exclude malfunction
· Ongoing hypotension, bradycardia or tachycardia
· Clinical signs of aortic stenosis, HOCM, heart failure, tamponade or dissection
· ECG abnormalities e.g. infarct/ischaemic change , LVH/strain pattern, AV block, LBBB, RBBB, trifascicular block, new arrhythmias, long QT >450ms, corrected short QT <350ms, short PR with delta wave, paced rhythms
Consider referral to a General Cardiology Clinic for:
· Recurrent episodes
· History or family history indicative of a cardiac cause
· Sustained an injury or are at risk of sustaining injury
· Had an episode at wheel of car
· Features suggestive of carotid hypersensitivity eg on head turning/neck pressure
· Abnormal cardiovascular examination eg a murmur
· Abnormal ECG
Consider referral to Care of the Elderly:
(Unless there is a strong indicator of significant arrhythmias or structural heart disease)
· Syncope of unknown cause in those >65 years
· Those with multiple co-morbidites/ polypharmacy
Consider referral to Neurology:
(Unless there is a strong indicator of significant arrhythymias or structural heart disease)
· Preceding aura/generalised seizure activity/ tongue biting
· Prolonged recovery
· Associated neurological symptoms/ signs
· Symptoms in keeping with known neurological process
A referral may not be appropriate if:
Patients have symptoms in keeping with orthostatic hypotension who have a normal examination and a normal ECG.
Prior to referral:
Recent FBC, U+E
Please ensure a recent 12 lead ECG is attached
Reference / further reading
NICE,ESC, map of medicine, 10
http://guidance.nice.org.uk/CG109
Date reviewed 05/07/2021
Next review due 05/07/2022
Sifter name Elizabeth Fell / Bridgitte Wesson
Contributors Dr Louise Melley – Assistant Specialist Cardiology RCHT
Version 2.1