Syncope, collapse and syncope-like events - pathophysiology, diagnosis and therapy

Syncope (fainting or fit) is a clinical presentation commonly encountered in veterinary practice. Witnessing a syncopal event can be a very dramatic experience for an owner. Syncope should always be considered as a clinical sign and not as a disease in itself. Depending on the underlying cause, it can impair the patient's quality of life, indicate a near sudden death, or have a benign course, and may even disappear without any treatment. Due to the number of different aetiologies and its intermittent occurrence, the diagnostic workup for this type of disease can be challenging. Also, an exact differentiation between syncope, syncope-like event, collapse, and epileptiform fits is not always possible. The diagnostic workup should always start with a thorough anamnesis. Asking the correct questions regarding the episode is essential and often points the clinician towards whether there is a cardiological or a neurological problem. Differential diagnoses include cardiovascular, pulmonary, neuroendocrine, or metabolic disease, and intoxications. This article gives an overview of the pathophysiological mechanisms and differential diagnoses of syncope and syncope-like events. The diagnostic workup and therapeutic options are also discussed.