Presyncope/Syncope

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

  • How often and for how long has it been happening?
  • * Recent onset and frequent events
  • Was the loss of consciousness complete and for how long?
  • Was there an aura, tongue biting, incontinence or seizure activity?
  • Was there any relationship to exercise?
  • Was there dyspnoea? (?PE)
  • Palpitations, chest pain or breathlessness
  • Family history of sudden cardiac death
  • Psychiatric history
  • Co-morbidities and medications
  • * Family history of sudden cardiac death
  • * Chest pain, palpitations and breathlessness with presyncope/syncope
  • * Exertional syncope
  • Examination:
    • Heart rate, BP including postural BP
    • Abnormal vital signs
    • Cardiac examination for murmurs or signs of CCF
    • Presence of neurology – myopathy with proximal weakness, hemiplegia

Tests

  • FBC
  • U&ECr
  • Calcium, Magnesium and Phosphate
  • * ECG - long QT, heart block
  • Holter monitor- if recurrent with palpitations
  • Echo- family history, abnormal cardiovascular examination

Interim/GP management

To refer a patient with this condition, please see the General Medicine clinic page for the full referral process and templates.

The presence of (*) could indicate a serious condition. Consider phoning the General Physician on call.

Please review the Assessing Fitness to Drive information located on Austroads website to provide accurate advice to your patient regarding driving eligibility.

Collapse in presence of GP may not need referral to ED.

Consider discussing with General Medical Unit.

For more information please see the Tasmanian Health Pathways website.

Emergency

Usually occurs following syncope/pre-syncope in a public place OR injury from the event OR elderly person found on floor following the event.

Urgent / category 1

Recent onset, recurrent events

Family history of sudden death

Syncope on exertion

Semi-urgent / category 2

Increasing frequency of events

Routine / category 3

Two to three events years apart

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

The patient should ask a friend who has witnessed the event to come to the appointment.

Please review the Assessing Fitness to Drive information located on Austroads website to provide accurate advice to your patient regarding driving eligibility.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

We will endeavour to see these patients within two weeks.

Please contact the General Medicine Consultant on-call if you have an urgent case to be reviewed. All referrals viewed by Consultant and allocated to Consultant or Unit Registrar. Registrar cases will be discussed with Consultant.

Semi-urgent:

We will endeavour to see these patients within eight weeks

Routine:

Next available appointment