Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Red flag symptoms in a patient presenting with syncope that should prompt immediate referral to secondary care include:
- History or physical signs of heart failure.
- Syncope occurring during exertion.
- Family history of sudden cardiac death in people younger than 40 years and/or an inherited cardiac condition.
- New or unexplained breathlessness.
- Presence of a heart murmur.
- Any abnormality on a 12-lead ECG, including conduction abnormalities (e.g., complete right or left bundle branch block, any degree of heart block), long or short QT interval, ST segment or T wave abnormalities, inappropriate persistent bradycardia, ventricular arrhythmias, Brugada syndrome, ventricular pre-excitation, ventricular hypertrophy, abnormal T wave inversion, pathological Q waves, sustained atrial arrhythmia, or paced rhythm.
- Transient loss of consciousness (TLoC) without prodromal symptoms in people aged over 65 years.
- Syncope associated with injury or incomplete recovery of consciousness.
These features require urgent cardiovascular assessment and referral, ideally within 24 hours, to a specialist service for further evaluation and management.