Clinical assessment and risk stratification

For patients presenting with syncope the first step of clinical assessment in a detailed history. This history is ideally taken not only from the patient themselves, but also from a bystander or witness to the event. Teasing out the presence of a prodrome, existence of myoclonic jerking or tonic-clonic seizure activity, bladder or bowel incontinence, or existence of a post ictal phase can help to discern a seizure from syncope. Presence of a fever, recreational drug or alcohol use is also important in helping to risk stratify and formulate a differential diagnosis.

A detailed family history must also be undertaken to ascertain if any first degree relatives has had SCD, or Brugada syndrome.

Clinical examination for these patients is often completely normal. It is important to ensure a thorough cardiovascular and neurological exam however, to exclude other causes for syncope.

Occasionally a patient may present with viral type symptoms or fever (or even routinely on health screening) and an opportunistic ECG will reveal Brugada pattern. In this case discussion should occur with cardiology for further work-up to assess for presence of Brugada syndrome.

Learning bite

A detailed history should be taken in anyone presenting with syncope including a thorough family history for unexplained cardiac death.

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