Neuro-Cardiogenic Syncope

Guidance for medical examiners when assessing a patient for either a general topic or condition - Neuro-Cardiogenic Syncope.

Aeromedical implications

Effect of aviation on condition

  • Possible trigger for syncopal event eg stress / anxiety, postural change

Effect of condition on aviation

  • Overt incapacitation from loss of consciousness
  • Subtle incapacitation during pre-syncopal phase
  • Distraction due to treatment and symptoms

Approach to medical certification

Based on the condition

  • Number of episodes
  • Pattern of episodes
  • Predictability of episodes
  • Comorbid disease

Based on treatment

  • Evidence for treatment effectiveness
  • Compliance with treatment

Demonstrated stability

  • No episodes during period of surveillance

Risk assessment protocol for significant syncope or pre-syncope - information required

New cases

Copies of the following reports will be required.

  • Ambulance reports
  • Hospital admission notes
  • Imaging reports
  • Hospital discharge letters
  • Eye-witness reports

A report from a Cardiologist will be required.

  • Confirmed diagnosis
  • Clinical status
    • history of syncopal or pre-syncopal episodes
    • triggers
    • symptoms
    • prior to episode - chest pain, palpitations, dyspnoea, visual disturbance
    • following episode - tongue biting, incontinence, post-ictal
    • duration
    • concomitant illnesses
    • family history
    • syncope, epilepsy, sudden death
    • other medical history
  • Investigations conducted
    • exercise ECG (required)
    • 24 hr ECG (required)
    • echocardiogram (required)
    • tilt table test (if indicated)
  • Management
    • treatment
    • side-effects
    • monitoring
  • Follow-up plan
  • Risk of recurrence / incapacitation (with reference to scientific literature where possible).

A report from a Neurologist may be required.

  • Confirmed diagnosis
  • Clinical status
    • history of syncopal or pre-syncopal episodes
    • triggers
    • symptoms
    • prior to episode - chest pain, palpitations, dyspnoea, visual disturbance
    • following episode - tongue biting, incontinence, post-ictal
    • duration
    • concomitant illnesses
    • family history
    • syncope, epilepsy, sudden death
    • other medical history
  • Investigations conducted
    • brain imaging (if indicated)
    • EEG (if indicated)
    • management
    • treatment
    • side-effects
    • monitoring
    • follow-up plan
    • risk of recurrence / incapacitation (with reference to scientific literature where possible).

Renewal

Treating doctor report (GP or specialist).

  • Clinical status
    • further episodes
  • Investigations conducted
  • Management
    • treatment
    • compliance with treatment
    • side-effects
  • Follow-up plan.

Indicative outcomes

Favourable

  • Single episode of syncope or pre-syncope secondary to documented minor illness
  • Single episode of syncope or pre-syncope secondary to trigger not present in aviation environment
  • Absence of syncope or pre-syncope during extended period of surveillance

Unfavourable

  • Significant abnormality on investigation
  • Recurrent and / or unpredictable syncope or pre-syncope

Pilot and controller information

  • Syncope and pre-syncope are aero-medically significant conditions
  • Pilots and controllers who experience syncope and pre-syncope should ground themselves and present to their DAME for review
  • Recurrent episodes may require an extended period of surveillance on the ground
  • Multi-crew restrictions may be required following period of surveillance

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

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