Syncope and orthostatic intolerance — formative SAQs

SAQ 1 — Exertional syncope with a family history (10 marks, 15 minutes)

A 13-year-old boy collapsed while sprinting the 400 metres at school. He had no prodrome. His father died suddenly at 34 years of age, and an uncle drowned in unclear circumstances. On examination the boy is fully recovered, his cardiovascular examination is normal, and his blood pressure is 110/70 with equal four-limb pulses. [5]

a) List the cardiac red-flag features in this vignette and explain why this presentation must be treated as cardiac syncope until proven otherwise. (3 marks) [5] [11]

b) Outline your immediate assessment and investigations, including the role of the ECG and the specific patterns you must exclude. (4 marks) [5]

c) Describe your disposition, including the advice on exercise, and the principles of managing the likely underlying condition. (3 marks) [11]