7. Dizziness/Syncope

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Headshot of Dawn Elise DeWitt, MD, MSc, CMedEd, MACP, FRACP, FRCP-London · Senior Associate Dean, Collaboration for InterProfessional Health Education Research & Scholarship (CIPHERS)
Dawn Elise DeWitt
MD, MSc, CMedEd, MACP, FRACP, FRCP-London · Senior Associate Dean, Collaboration for InterProfessional Health Education Research & Scholarship (CIPHERS)
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Table of Contents

Author

Dawn DeWitt, MD

In this module

Overview

  • “Dizziness” (“feeling faint,” pre-syncope) is experienced by almost everyone.
  • Temporary loss of consciousness due to decreased blood flow to the brain (fainting).
  • 1 of every 30 ED visits.
  • Differentiate from vertigo—a feeling of movement, spinning, motion sickness
    • Main causes: BPV, Meniere’s, 8th nerve tumour, posterior circulation stroke.
    • Asking the question and specific PE maneuvers.

Convulsive syncope

This video, from a study with medical students who volunteered to illustrate what happens when you “pass out,” shows how the associated movements can be confused with seizure activity.  

Fainting dead away: Cardiogenic syncope

Here is a good parallel video on Cardiogenic Syncope from an expert.

Advice on history-taking from Dr. Mesher (neurologist): “Try to describe your symptoms without using the word dizzy.”

Causes of syncope Frequency

Cardiac

  • Arrhythmias
  • Other (valvular, ischemia)

11–18%

  • 7–14%
  • 3–4%

Neurocardiogenic

  • Vasovagal
  • Carotid sinus

24–68%

  • 37%
  • 1%
Orthostatic hypotension
8–24%
Psychiatric
2%
Unknown
14%

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