Case 4 – Syncope

You are seeing Mrs. Diaz, a 68 year old female, who is in your office because she says she has recurrent episodes of ‘fainting.’ Take a focused history of her complaint.



  • Onset of syncope
  • Timing of syncope
  • Frequency
  • Duration of syncopal episodes
  • Activity surrounding syncope
  • Changes in position before syncope
  • Distinguishes if true syncope, i.e. full loss of consciousness

Pre-syncopal signs and symptoms

  • Distinguishes syncope from dizziness and vertigo
  • Chest pain before syncope
  • Shortness of breath
  • Palpitations
  • Focal neurologic deficits (vision, numbness, weakness)
  • Systemic neurologic deficits

Post-syncopal signs and symptoms

  • Post-ictal confusion
  • Incontinence
  • Weakness
  • Personal history of heart disease
  • Personal history of seizure
  • Cardiac risk factors
  • Family history of heart disease, seizure disorders
Case 4 – Syncope