[Syncope]

Syncope is a transient, self-limiting loss of consciousness usually leading to a fall. The onset of syncope is relatively rapid and the subsequent recovery is spontaneous, complete and usually prompt. As syncope is a symptom, the aim of the diagnostic work-up is to assess whether there is a syncope or another "nonsyncopal" condition, whether there are clinical features suggesting the diagnosis, whether the patient has an increased risk for mortality or recurrent episodes, and whether the patient must be admitted to hospital. The diagnostic work-up is given for two cases: a 68-year-old male with insulin-dependent diabetes experienced his first syncope after lunch. The clinical judgment suggested a neurocardiogenic syncope. The initial evaluation consisting of history, physical examination and twelve-lead ECG evidenced that the patient received several drugs for arterial hypertension so that an orthostatic hypotension had to be ruled out. The twelve-lead ECG showed a left bundle branch block suggesting an arrhythmic syncope and the need for additional diagnostics: an echocardiography mainly to assess the left ventricular function which was normal, and a 24-h long-term ECG to rule out arrhythmias which were not observed. The patient gets an explanation of his risk and the reassurance about his excellent prognosis and some preventive lifestyle modifications such as sufficient volume intake. The second case is a sick 58-year-old male with tracheal cough und aggravating breathing who had a syncope on his way to the toilette. The cause of the syncope was related to a bronchitis with high fever. The patient received a causative treatment and recovered completely.