Vasovagal Syncope (General Medicine)

Vasovagal syncope (neurocardiogenic): commonest cause of transient LOC. Classic features: • Prodrome: warmth, nausea, sweating, light-headed, tunnel vision, ringing in ears. • Triggers: prolonged standing, heat, dehydration, stress, pain, sight of blood / needles, urination (micturition syncope), cough (cough syncope), defecation, hot tubs. • Brief LOC + rapid recovery. • Pallor during episode. • Brief myoclonic jerks possible (DO NOT confuse with seizure). • No post-ictal confusion. • Usually upright posture; lying down rarely vasovagal. Differentials: cardiac (arrhythmia, structural — see syncope pathway), seizure, orthostatic hypotension, drug-induced, hypoglycaemia.