Red flags
- Syncope during exertion
- Family history SCD
- Abnormal ECG (long QT, Brugada, HCM, WPW)
- Structural heart disease
- Sudden collapse without prodrome
First steps
- Full history: prodrome, triggers, witnesses, injury
- 12-lead ECG + orthostatic BP
- Cardiac exam
Key investigations
- 12-lead ECG
- Echo if structural heart disease suspected
- Tilt table if vasovagal likely
- Holter/loop recorder if arrhythmia suspected
Differentials
- Vasovagal
- Orthostatic hypotension
- Cardiac (arrhythmia, structural)
- Seizure
- Hypoglycaemia
Initial management
- Vasovagal: education, hydration, counter-manoeuvres
- Orthostatic: review drugs, compression stockings, midodrine
- Cardiac: treat cause; ICD if life-threatening VT
Referral
- Cardiology for cardiac cause
- Neurology if seizure/TIA suspected
AI clinical assessment
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