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Neuro-Cardiogenic Syncope
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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 & 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
- 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
Disclaimer
The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer
