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Fits and faints history taking


Differential diagnoses

Vasovagal syncope

Cardiac syncope (aortic stenosis, arrhythmias)

Generalised tonic-clonic seizure (GTCS)

Other epileptic seizure

Postural hypotension

Situational syncope



  • Wash hands and introduce yourself
  • Check the patient’s full name and DOB
  • Ask the patient if it is okay to talk through their symptoms with them


History of presenting complaint

  • Ask the patient what has brought them here today
  • Ask them to tell you more about the fit/faint
  • Checks for GTCS
    • Ask about prodrome
      • Did they feel it coming on (frequent in vasovagal, less so in GTCS)
    • Ask if they remember hitting the floor
    • Ask how long they were unconscious for
    • Ask if they bit their tongue or were incontinent
    • Ask if they had any jerking movements
      • Their whole body, or only part of it? (GTCS is whole body)
    • Ask if they hurt themselves
    • Ask if they were confused or drowsy when they woke up
    • Ask if their muscles hurt when they woke up
    • Ask if this has ever happened before
    • Get history from a witness if possible
  • Checks for cardiac syncope/MI
    • Ask if they have been having chest flutters/palpitations
    • Ask about chest pain
    • Ask about SOB
  • Check for postural hypotension
    • Ask if they often get dizzy when they stand up
  • Check for situational syncope
    • Do they feel dizzy or faint after micturition or coughing
  • Checks for vasovagal/faint, also important for epilepsy, as these factors can bring on a seizure
    • Ask if have been feeling unwell recently
    • Ask about stress
    • Ask about dehydration and whether they’ve eaten enough
    • Ask if they were overly hot
    • Ask if they’ve been having enough sleep recently
    • Ask if they’ve fainted before
  • Ask if there is anything in particular that they are worried about
  • Ask if there is anything that they think might have caused the fit/faint
  • Systems review
    • Weight loss, appetite change
    • Fatigue
    • Headaches
    • Changes in vision or sensation
    • Cough
    • SOB
    • Change in bowel habit
    • Change in waterworks
    • Aches and pains
    • If they have regular periods, and any change. Any chance of pregnancy


Past medical history

  • Ask if they have any health problems
  • Ask about epilepsy as a child
    • Ask if they ever had vacant episodes as a child (undiagnosed absence seizures)
  • Ask about heart problems
  • Ask about blood pressure
  • Ask if they are diabetic (ask earlier if suspect a hypo)


Drug history

  • Ask if they take any medication, and if there have been any changes
  • Ask about anti-hypertensives
  • Ask about over the counter
  • Ask about supplements



  • Ask if they have any allergies
  • Ask what happens


Family history

  • Family history of:
    • Epilepsy
    • Heart disease
  • Any other health problems in the family


Social history

  • Ask about their occupation
  • Ask about stress
  • Ask who they live with
  • Ask about drinking and weekly units
  • Ask about smoking and pack years



  • Ask if they have any questions
  • Ask if they think you have missed anything out that they wanted to tell you about
  • Summarise and check with the patient
  • Thank the patient for talking to you


Explaining epilepsy

  • Everyone has the potential to have a fit, but with people the epilepsy the threshold is much lower
  • Triggers for fits are stress, strong emotions, lack of sleep, unhealthy lifestyle
  • Exercise can help, as can relaxation and eating healthily
  • The fit itself is a flurry of electrical signals in the brain, that starts in one place and spreads, which overwhelms the brain, and leads to the fit




Vasovagal syncope (faint)

Often precipitated by fear, heat, dehydration, pain, standing

Often a prodrome of nausea, sweating, vision and hearing loss

Loss of consciousness is brief, <2 minutes, patient may remember hitting ground

May have some jerking movement, no post-ictal state of confusion or drowsiness

Situational syncope

Precipitated by micturition or coughing, especially in the older patient

Loss of consciousness is brief

May have prodrome of nausea, dizziness, vision/hearing loss, no post-ictal

Postural hypotension

Loss of consciousness associated with standing up, or sitting up from laying

May have dizziness on standing

Cardiac syncope (eg aortic stenosis, arrhythmias)

Likely to be sudden loss of consciousness with no prodrome, palpitations, tachycardia (arrhythmia)

Chest pain and syncope on exertion, SOB, pink frothy sputum, leg swelling (aortic stenosis


SOB, central crushing chest pain, radiation, anxiety, clammy


May or may not have prodrome, may have aura (sensory or déjà vu)

Loss of consciousness, falls, tonic stiffening, cloning jerking (rhythmic, symmetrical), lasts up to 30 seconds, may have post-ictal phase of confusion, headage, amnesia, drowsiness

May be incontinent of urine/faeces, may bite side of tongue

Other epileptic seizure

Absence: unresponsive, eyes glazed for up to 10 seconds, no loss of consciousness, common in children

Tonic: tonic stiffening only

Clonic: clonic jerking only

Atonic/akinetic: sudden loss of muscle tone, loss of consciousness, collapse


Diabetic, history of reduced food intake, or insulin overuse

Sweating, dizziness, tiredness, muscle shakiness, pallor, palpitations, blurred vision, lip tingling, irritability, difficulty concentrating, drowsiness, confusion, ‘drunken behaviour’





In all cases

ECG, FBC, full neurological exam, BP

Orthostatic hypotension

Lying and standing BP, treat with midodrine

Cardiac syncope

Echocardiogram, referral to cardiology


EEG, referral to neurology treat with CCBs (gabapentin), Na channel blockers (phenytoin, carbamazepine, lamotrigine), GABA enhancers (benzodiazepines, phenobarbital, vigabatrin) or valproate (is CCB, SCB + GABA enhancer)


Improve diabetes control, education, ensure no underlying cause






Fits and faints history.docx
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