You have been referred to the Falls and Syncope Service by your family doctor or another doctor or nurse involved in your care.
We hope that reading this information will reduce any anxiety that you may have about your appointment. It will also help the doctors and nurses looking after you if you are well prepared and have all the important information readily to hand.
Why do I need this appointment?
The majority of people we see in this department are referred because they are suffering from falls, dizziness and loss of consciousness. Some people complain of only one of these symptoms, while others may have more than one symptom. The people referred to our service are adults across the full range of age.
Your doctor has referred you for help with diagnosis and treatment of the problems you have been having. It may be that you have had a significant injury as the result of a fall or blackout. Or it may be that you have lost your confidence because you are frightened of falling or losing consciousness.
Please let us know if the appointment offered to does not suit. We can rearrange this for you and may be able to offer the appointment to another patient.
Process of assessment
Currently all new patient appointments take the form of telephone consultations carried out by senior doctors working within the unit. In order to come to a diagnosis, the doctor will first need to take a careful history of your symptoms. Some details can seem quite trivial, but still provide important clues to the diagnosis.
If you have experienced loss of consciousness or near loss of consciousness, it is very helpful to have a description of the episode from someone who saw it. We therefore ask that, if possible, someone who has witnessed your episodes is also available to provide an account of your symptoms.
If you live in a residential or nursing home, or are reading this information on behalf of a resident, please note that this advice also applies to carers. It is very helpful to us if a member of care staff who knows you, or the patient, well and has witnessed an episode, is available to provide additional information if required.
The doctor will also ask you about your past medical history, whether any illnesses run in your family and seek details around your social setting and functioning.
It is very important that we have an accurate and up to date list of your current medications (including doses). It would be greatly appreciated if you have this information readily to hand at the time of your appointment.
Plan of action
At this point the doctor conducting the appointment may be able to diagnose a cause for your symptoms and offer a tailored management plan.
Alternatively the doctor may feel that further investigations are required in order to help clarify the cause of your symptom. These will be organised as part of an outpatient appointment. The most common investigations carried out at this point are:
- ECG
- 24hr ECG
- 24hr blood pressure monitor
- Prolonged (1 week) ECG \ monitor
- CT scan / MRI scan of head
In addition, the doctor may think that a face-to-face assessment within the Falls and Syncope Service itself would help to accurately evaluate your symptoms. This also means that a physical examination can be carried out if appropriate.
A nurse will also be present during any physical examination. However if you wish for a friend or relative to be present, please let our staff know.
Where indicated by your history, the doctor may suggest that further tests be carried out such as:
12 Lead ECG
This is done by placing sticky ‘pads’ – electrodes – on the skin of the chest and limbs in order to record the electrical activity from the heart. It is used to check that your heart rhythm is normal, and see if there is any evidence of a previous heart attack.
Active stand
You will be asked to lie on a bed while the nurse attaches a blood pressure monitor. A cuff will be put around your upper arm, similar to the cuff that your family doctor uses to take your blood pressure. A second cuff will be placed on your fingers. This records the blood pressure with each heartbeat. You will feel this cuff gently squeezing your finger.
After resting for 10 minutes, the nurse will help you to stand up quickly. The equipment monitors the changes in your heart rate and blood pressure as you stand. If your blood pressure does change, you may experience some light-headedness or dizziness. Please tell the doctor or nurse how you are feeling.
Head up tilt test
A ‘Head Up Tilt Test’ is used to help diagnose a fainting tendency. It is similar to the ‘Active Stand’, but rather than actively moving from a lying to standing position, the bed moves the patient from a lying position to the upright position.
The purpose of the test is to see if it can precipitate your symptoms and show what your blood pressure and heart rate is doing at the same time. Staff may administer a GTN spray under your tongue as part of the test in order to encourage a drop in blood pressure to see if this precipitates symptoms. The ‘Head Up Tilt Test’ can last up to 40 minutes.
Blood tests
We will also need to take a blood sample from you. This will be taken by a nurse or a doctor.
How should I travel to the clinic?
Please do not drive yourself to the clinic. This is because some of the tests we perform may make you feel dizzy and you may not be fit to drive home. In some cases you may be advised by the doctor that you should not drive until all investigations have been completed.
Your consent
We wish to make sure that you feel involved in your assessment and treatment. If you feel unhappy about any of the above procedures and do not wish to have a particular examination or test, please let the doctor or nurse know.
Data Protection Act
We will record information about your condition on an electronic database accessible only to members of staff in the department. This will enable us to send out follow up appointments and audit standards of care in the department. Some of the data may be used for research purposes, but if it is used in this way it will be anonymised and not traceable back to you. If you do not wish to have any data about your recorded on computer, please let us know. If you are happy with us recording this information, we will ask you to sign a disclaimer in your notes.
What happens next?
All of the information that we have collected about you will give us a clear idea about your condition. In some cases, further tests may be needed at another appointment.
We hope that you have found this information helpful and look forward to meeting you when you come for your appointment. If you have any questions call us:
Telephone 0191 282 0481
Monday to Friday 8.30am – 4.30pm
