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