Presyncope/Syncope

This condition is treated in the General medicine clinic.

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 HealthPathways Tasmania website.

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.

Clinic appointments

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

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.

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

? Recent onset, recurrent events

? Family history of sudden death

? Syncope on exertion

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 (Category 2)

Increasing frequency of events

Routine (Category 3)

Two to three events years apart

Next available appointment

Availability

North

Launceston General Hospital (Level 3)
Phone: 1300 977 694
Fax: 03 6777 5227

North West

North West Regional Hospital
Phone: 6493 6300
Fax: 6464 1928

Mersey Community Hospital
Phone: 1800 636 455 
Fax: 6441 5928

South

Wellington Clinics (Level 10)
Phone: 03 6166 0000
Fax: 03 6234 3982