Wrap Up

• Note the steps followed by Dr. Winston:
  • Background
  • Timing (frequency)
  • Setting
  • Onset
  • Recovery
  • Other spells
    This is a good outline to use in interviewing any patient with syncope.
• This patient’s history was consistent with Neurocardiogenic syncope:
  • Low likelihood of structural heart disease
  • Several episodes
  • Standing position
  • Classic prodromal symptoms
  • Uneventful recovery ( pallor, diaphoresis )
  • Prolonged asthenia after the attack (hours)
• The physical examination and resting ECG in this case were normal as expected.

• Tilt-table testing is the only appropriate diagnostic technology for patients with suspected neurocardiogenic syncope. This was not recommended at this time in this patient.