Clinical Clues to Different Types of Syncope or Pseudo-syncope

Trigger or Finding

Type

after exertion

vagovagal

after exertion

autonomic failure

associated with nausea and vomiting

vagovagal

associated with throat or facial pain

neuralgia (trigeminal or glossopharyngeal)

blue face

seizure

confusion after an attack for > 5 minutes

seizure

difference between the arms in pulse and/or blood pressure

subclavian steal

difference between the arms in pulse and/or blood pressure

aortic dissection

dysarthria, diplopia, vertigo

vertebro-basilar TIA

epileptic aura

seizure

family history of sudden death

long QT syndrome

family history of sudden death

Brugada syndrome

family history of sudden death

hypertrophic cardiomyopathy

family history of sudden death

right ventricular dysplasia

palpitations

tachyarrhythmia

postprandial (within 1 hour of a meal)

autonomic failure

somatic complaints with negative workup for organic heart disease

psychogenic

temporal link to start of a drug or a change in dosage

drug induced

tonic-clonic movements, automatisms, tongue biting

seizure

triggered by a sudden and unexpected stimulus (sound, sight, smell, etc)

vasovagal

triggered by active standing

orthostatic hypotension

triggered by arm exercises

subclavian steal

triggered by exertion

cardiac syncope

while lying supine

cardiac syncope

while standing in a crowded, warm place or after prolonged standing

vasovagal

while standing in a crowded, warm place or after prolonged standing

autonomic failure

with head rotation

carotid sinus syncope

with pressure on the carotid sinus (tight shirt collar, etc)

carotid sinus syncope