Causes of collapse2
| Differential diagnosis | Clinical clues |
|---|---|
| *Common causes | |
| †Rare causes | |
| Hypoxia, hypoglycaemia | Should be picked up in primary survey |
| Do not forget the glucose | |
| Epilepsy* | Previous history, postictal period |
| Affective (psychological) | History of anxiety or panic disorder, hyperventilation |
| Dysfunction of brain stem—for example, vertebrobasilar transient ischaemic attack, basilar migraine | Cerebellar signs on neurological examination |
| Heart—for example, ischaemic heart disease | Recent chest pain, history of myocardial infarction |
| Emboli—pulmonary embolism | Pleuritic chest pain, dyspnoea, calf pain, or swelling |
| Aortic obstruction—for example, stenosis, hypertrophic obstructive cardiomyopathy (HOCM)† | Precipitated by exertion, cardiac murmur on auscultation |
| Rhythm disorders—for example, sick sinus syndrome, complete heart block | May be picked up on primary survey if heart rate <50, history of ischaemic heart disease |
| Tachydysrhythmias—for example, SVT, VT, long QT syndrome | History of palpitations, may be picked up on primary survey if heart rate >100, <5 s prodromal period |
| Vasovagal* | Prodrome of nausea, dizziness, yawning, sweaty |
| ENT—for example, Ménière’s disease, acute labyrinthitis, benign paroxysmal positional vertigo | History of vertigo, deafness, tinnitis. nystagmus on neurological examination |
| Situational—for example, fright, micturition, deglutition, defaecation | May be apparent from history |
| Sensitive carotid sinus | Precipitated by head movement |
| Ectopic pregnancy** | History of abdominal pain, amenorrhoea, PV bleeding, positive pregnancy test |
| Low vascular tone | |
| Subclavian steal** | Precipitated by upper arm exertion |
| DRUGS—for example, antihypertensives, sympathetic blockers causing postural hypotension* | Elderly patient on multiple drugs |
| Postural fall in blood pressure | |