Dizziness / Syncope Triage
Spot high-risk fainting over the phone — the features that mean cardiac until proven otherwise.
Learning Objectives
- 1.Differentiate lightheadedness from true syncope.
- 2.Recognize high-risk syncope features.
- 3.Route dizziness/syncope calls by urgency.
Purpose
Most fainting is benign (vasovagal), but exertional or warning-less syncope can signal a dangerous heart problem. The history is everything.
What to ask
- •Did they actually pass out, or just feel lightheaded?
- •What were they doing — exertion, standing up, emotional/painful trigger?
- •Any warning (nausea, sweating, tunnel vision) or none at all?
- •Chest pain or palpitations before it?
- •Injury from falling? History of heart disease or family sudden death?
High-risk features — escalate
- •Syncope during exertion or exercise.
- •Syncope with NO warning (sudden, "lights out").
- •Syncope preceded by chest pain or palpitations.
- •Injury from the episode, or recurrent episodes.
- •Known heart disease or family history of sudden death.
Escalate
Exertional or warning-less syncope, or syncope with chest pain/palpitations, is cardiac until proven otherwise — urgent/emergent escalation and provider notification.
Lower-risk pattern
- •Classic vasovagal: clear trigger (pain, standing, heat, emotion), warning symptoms, quick full recovery — still route per protocol.
What to send the provider
- •True LOC vs. lightheaded, activity at onset, presence/absence of warning, associated chest pain/palpitations, injury, history, urgency read.
Patient education script
- •"Because you passed out during exercise with no warning, you need to be seen urgently — don’t drive yourself."
Spanish phrase
Did you faint while exercising, or with no warning at all?
¿Se desmayó mientras hacía ejercicio, o sin ningún aviso?
seh des-mah-YOH mee-EN-tras ah-SEE-ah eh-her-SEE-syoh, oh seen neen-GOON ah-VEE-soh
Mini case
A 55-year-old passed out suddenly while jogging, no warning, brief, then felt normal.
Is this low or high risk?
Show answer
High risk — exertional, warning-less syncope is concerning for a dangerous cardiac cause (arrhythmia or structural). Escalate urgently, advise no driving, and notify the provider; do not treat as benign vasovagal.
Checklist
- Clarified true syncope vs. lightheadedness.
- Asked about exertion, warning, and associated symptoms.
- Escalated high-risk features; advised against driving.