History

Important points to glean from a history of syncope:

• ask an observer to describe attacks
  
  
• generally the patient has some warning sensation of faintness, blurring of vision, dizziness or nausea
  
  
• if patient loses consciousness, then they are generally unconscious before hitting the ground
  
  
• syncope as a result of orthostatic hypotension occurs only when the patient is sitting or standing at the time of onset
  
  
• generally the patient is only unconscious for a short period of time unless the patient is sat up, resulting in more prolonged cerebral hypoxia
  
  
• convulsions are uncommon in syncope unless the patient is sat up, in which case the seizure is a reflex response to cerebral hypoxia
  
  
• the patient rapidly becomes orientated once consciousness is regained, this is in contrast with the confusion following an epileptic seizure
  
  
• if syncope is as a result of palpitations, then these occur at the start of the episode
  
  
• patients with parkinsonism or diabetes are prone to the development of postural hypotension; this is also true of patients taking hypotensive medication e.g. diuretics
  
  
• incontinence and tongue biting are uncommon in syncopal attacks but are more common in epileptic seizures