A 72-year-old female suddenly collapsed in church. When you arrive, she is awake but feels funny. Witnesses tell you she did not have a pulse and after three minutes she woke up. You should suspect:

• A. transient ischemic attack
• B. syncope
• C. hypoglycemia
• D. heart attack

Answer: (B)

Syncope—a temporary loss of consciousness from a brief drop in blood flow to the brain—is the best fit. In this scenario the patient suddenly collapses, is awake afterward and reports feeling funny, and there’s a period where there was no pulse followed by recovery. That pattern matches a transient loss of cerebral perfusion with spontaneous return of circulation, which is the hallmark of syncope.

A transient ischemic attack would present with sudden neurological symptoms (such as weakness, facial droop, trouble speaking) rather than a collapse with brief pulse absence. Hypoglycemia can cause altered mental status or confusion and may include sweating or tremors, but the classic clue here is the transient, self-limited loss of pulse and quick recovery rather than hypoglycemic signs. A heart attack typically presents with chest pain or discomfort, shortness of breath, and ongoing symptoms rather than a brief, self-terminating episode with rapid return to baseline.

In the field, keep the patient monitored, assess vitals, check glucose if indicated, and transport for evaluation since syncope can have serious underlying causes in an older adult.