From the Guidelines
The recommended HPI template for a patient presenting with syncope should include a detailed history of the present illness, focusing on the circumstances prior to the attack, onset of the attack, and the attack itself, as well as the patient's background and medical history, as outlined in the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1.
Key Elements of the HPI Template
The template should include the following key elements:
- Position and activity prior to the attack (e.g., supine, sitting, standing, rest, change in posture, exercise) 1
- Precipitating factors (e.g., crowded or warm places, prolonged standing, post-prandial period, fear, intense pain, neck movements) 1
- Onset of the attack, including symptoms such as nausea, vomiting, abdominal discomfort, feeling of cold, sweating, aura, pain in neck or shoulders, blurred vision, dizziness, and palpitations 1
- Description of the attack, including the way of falling, skin color, duration of loss of consciousness, breathing pattern, and movements 1
- Post-attack symptoms, such as nausea, vomiting, sweating, feeling of cold, confusion, muscle aches, skin color, injury, chest pain, palpitations, and urinary or fecal incontinence 1
- Background and medical history, including family history of sudden death, congenital arrhythmogenic heart disease or fainting, previous cardiac disease, neurological history, metabolic disorders, and medication use 1
Importance of a Comprehensive HPI Template
A comprehensive HPI template is essential for distinguishing between cardiac, neurological, and vasovagal causes of syncope, which is crucial for appropriate management and risk stratification 1. Cardiac causes of syncope carry a higher mortality risk, so thorough documentation of cardiac risk factors and symptoms is essential for proper treatment planning 1.
Additional Considerations
The HPI template should also capture potential contributing factors such as dehydration, recent illness, or alcohol consumption, and should include a detailed physical examination, including determination of orthostatic blood pressure and heart rate changes, and a basic neurological examination 1.
From the Research
HPI Template for Syncope
The recommended HPI (History of Present Illness) template for a patient presenting with syncope includes:
- A detailed description of the syncopal event, including the duration of loss of consciousness and any preceding symptoms or triggers 2, 3
- An assessment of the patient's medical history, including any previous episodes of syncope, underlying medical conditions, and current medications 4, 5
- A review of systems to identify any potential causes of syncope, such as cardiac, neurological, or orthostatic factors 2, 3
- An evaluation of the patient's symptoms, including any prodromal symptoms, such as dizziness, lightheadedness, or nausea, and any post-syncopal symptoms, such as headache or fatigue 3, 4
Key Components of HPI
The key components of the HPI for syncope include:
- Onset and duration of symptoms
- Description of the syncopal event, including any witnesses' accounts
- Preceding symptoms or triggers
- Medical history, including any previous episodes of syncope
- Current medications and potential interactions
- Review of systems to identify potential causes of syncope
Importance of HPI in Syncope Evaluation
A thorough HPI is essential in the evaluation of syncope, as it can help identify the underlying cause of the condition and guide further diagnostic testing and treatment 2, 3, 4, 5. The HPI can also help assess the patient's risk of adverse outcomes and inform decisions regarding hospital admission and management.