Transient Loss of Consciousness (TLoC) is very common: it affects up to half the population in the UK at some point in their lives.
TLoC may be defined as spontaneous loss of consciousness with complete recovery. In this context, complete recovery would involve full recovery of consciousness without any residual neurological deficit. An episode of TLoC is often described as a ‘blackout’ or a ‘collapse’, but some people collapse without TLoC. There are various causes of TLoC, including cardiovascular disorders (which are the most common), neurological conditions such as epilepsy, and psychogenic attacks.
The diagnosis of the underlying cause of blackout is often inaccurate, inefficient and delayed. There is huge variation in the management of blackout. A substantial proportion of people initially diagnosed with, and treated for, epilepsy have a cardiovascular cause for their blackout. Some people have expensive and inappropriate tests or inappropriate specialist referral (unnecessary referral or referral to the wrong specialty); others with potentially dangerous conditions may not receive appropriate assessment, diagnosis and treatment. The Lancashire Blackout clinic aims to reduce / eliminate this.
Lancashire Blackout Clinic is a Nurse-led, multi-discipline clinic that reviews patients that have experienced one or more blackout episodes. The clinic has been designed collaboratively with Cardiology, Neurology, Medicine and ENT input.
The patient is assessed in clinic within two to four weeks of referral. This assessment includes a detailed history, physical examination and appropriate investigations. Within the setting of the clinic, we have the facilities to do 12 lead ECG, 24 / 48 / 72 hr ECG monitoring and ECHO. We have rapid access to the Tilt Test, Cardio Memo and Implantable Loop recorder service if appropriate. Following the assessment, the patient is either given a diagnosis and appropriate treatment/advice initiated or if indicated, further investigations are organised. Following assessment if necessary patients are triaged down the appropriate rapid access pathway to Neurology, Cardiology, Care of the Elderly or ENT.
The referral criteria is anyone over the age of 16 who has experienced a blackout ( TLOC, Pre- syncopy, syncopy, collapse). The exclusion criteria for referral is:
No patients under the age of 16.
ECG abnormality:
- Persistent Bradycardia
- Ventricular arrhythmia
- Long QT
- Brugada Syndrome
- Ventricular pre excitation
- Sustained atrial arrhythmia
- Abnormal T wave inversion
- ST elevation /depression
- Paced rhythm
- Heart failure
- New onset SOB
- New murmur
- Chest pain
- History of brain trauma
- Dementia
- Mechanical fall
- Alcohol and drug misuse at the time of collapse
