Blackout and collapse in older adults

'Collapse query cause' is a common acute medical presentation with many different causes. This article focuses on syncope, which is caused by transient global cerebral hypoperfusion. There are four main subtypes of syncope, with neurally mediated syncope and syncope caused by orthostatic hypotension being by far the most common. Cardiac arrhythmias account for only 20% of syncopal episodes. The initial evaluation is extremely important and leads to a diagnosis in 40% of cases. Only some patients need investigation, and deciding what investigations to request depends on the person's history, whether they have structural heart disease and whether the syncope is frequent or severe. The evaluation of syncope is often unstructured and varies considerably among doctors. The European Society of Cardiology guidelines on syncope remain the standard for syncope specialists.