From the Guidelines
When evaluating a female patient who experienced syncope after ovarian/endometrial tumor removal surgery, it is crucial to ask about the circumstances just prior to the attack, including position, activity, and predisposing factors, as outlined in the 2009 European Heart Journal guidelines 1. To determine the cause of the syncopal episode, ask about the following:
- Position (supine, sitting, or standing) and activity (rest, change in posture, exercise, or specific actions like urination or defecation) prior to the episode
- Predisposing factors, such as crowded or warm places, prolonged standing, or post-prandial period
- Precipitating events, like fear, intense pain, or neck movements
- Onset of the attack, including symptoms like nausea, vomiting, abdominal discomfort, feeling of cold, sweating, aura, pain in neck or shoulders, blurred vision, or dizziness
- Palpitations or other cardiac symptoms
- The attack itself, including eyewitness accounts of the way of falling, skin color, duration of loss of consciousness, breathing pattern, and movements
- The end of the attack, including symptoms like nausea, vomiting, sweating, feeling of cold, confusion, muscle aches, skin color, injury, chest pain, palpitations, or urinary or fecal incontinence
- Background information, such as family history of sudden death, congenital arrhythmogenic heart disease, or fainting, as well as previous cardiac disease, neurological history, metabolic disorders, or medication use According to the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope 1, it is essential to consider various types of syncope, including reflex syncope, orthostatic hypotension, cardiac syncope, and noncardiac syncope, when evaluating the patient's symptoms and history. The most critical questions to ask are those that help identify potential causes of postoperative hypotension, such as hemorrhage, hypovolemia, vasovagal response, medication side effects, or early infection, as these can significantly impact morbidity, mortality, and quality of life 1.
From the Research
Questions to Ask a Female Patient After a Syncopal Episode
After undergoing ovarian or endometrial tumor resection surgery, a female patient who experienced a syncopal episode should be asked the following questions:
- What were the circumstances surrounding the syncopal episode, such as the time of day, activities prior to the episode, and any potential triggers 2?
- Did the patient experience any prodromal symptoms, such as dizziness, lightheadedness, or nausea, before the syncopal episode 2?
- Has the patient experienced any previous episodes of syncope or near-syncope 2?
- Are there any underlying medical conditions, such as heart failure, abnormal vital signs, or ECG abnormalities, that could contribute to the syncopal episode 2?
- Did the patient undergo any preoperative testing, such as echocardiography or electrocardiography, that could provide insight into the cause of the syncopal episode 3?
- What was the patient's vital sign status, including blood pressure, heart rate, and oxygen saturation, during and after the syncopal episode 4?
- Did the patient receive any medications or interventions, such as fluid resuscitation or oxygen therapy, during or after the syncopal episode 4?
- Are there any potential complications or side effects from the surgery that could contribute to the syncopal episode, such as bleeding, infection, or reaction to anesthesia 5, 4?
Additional Considerations
The patient's medical history, including any previous surgeries or medical conditions, should be reviewed to identify potential risk factors for syncope 2. A thorough physical examination, including orthostatic blood pressure recording and ECG, should be performed to diagnose the cause of the syncopal episode 2. The patient's symptoms and vital signs should be closely monitored, and any necessary interventions or medications should be administered promptly 4.