Syncope: A practical approach to diagnosis

Syncope is commonly encountered clinical problem by practicing clinicians. This is defined as a transient loss of consciousness resulting from decrease in cerebral perfusion. The importance of evaluation of this condition cannot be undermined as it has been said that syncope and death differ from each other in that in the former the patient wakes up while in the latter he does not. Occurrence of this event on one hand results in psychological duress to the patient and their relatives while on the other hand, it can be sometimes be a challenge to the treating physician to be able to confidently classify this as benign. Patient with syncope may present to different medical specialists - Physician, cardiologist, Neurologist, Emergency room physician or to a psychiatrist. Unless there is clarity in the mind of the clinician of the diagnostic plan, what will result is large number of expensive and non-contributory diagnostic tests, prolonged hospital stay leading to financial burden to the patient and frustration to the doctor. In the following paragraphs I will try to summarize the approach to the diagnosis of common conditions causing syncope. One should nevertheless be aware that in a significant number of cases, the cause of syncope cannot be exactly pinpointed. A physician should however be able to definitively exclude life threatening causes of syncope. This is a more achievable and important objective to achieve. Keywords: Syncope; pre-syncope