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SYNCOPE


Available online
Task Force Report
Guidelines on management (diagnosis and treatment)
of syncope*

Task Force on Syncope, European Society of Cardiology†: M. Brignole (Chairman),
P. Alboni, D. Benditt, L. Bergfeldt, J. J. Blanc, P. E. Bloch Thomsen, J. G. van Dijk,
A. Fitzpatrick, S. Hohnloser, J. Janousek, W. Kapoor, R. A. Kenny, P. Kulakowski,
A. Moya, A. Raviele, R. Sutton, G. Theodorakis and W. Wieling


Table of contents

Preamble – Scope of the document 1256 – Method 1257

  • Part 1. Classification, epidemiology and prognosis
    Definition 1258
    Brief overview of pathophysiology of syncope 1258
    Classification 1259
    Epidemiological considerations 1259
    Prognostic stratification: identification of factors
    predictive of adverse outcome 1260

  • Part 2. Diagnosis
    Strategy of evaluation (flow chart) 1262
    Initial evaluation (history, physical examination,
    baseline electrocardiogram) 1264
    Echocardiogram 1266
    Carotid sinus massage 1266
    Tilt testing 1268
    Electrocardiographic monitoring (non-invasive
    and invasive) 1271
    Electrophysiological testing 1273
    ATP test 1277
    Ventricular signal-averaged electrocardiogram 1278
    Exercise testing 1278
    Cardiac catheterization and angiography 1279
    Neurological and psychiatric evaluation 1279
    Diagnostic yield and prevalence of causes
    of syncope 1282

  • Part 3. Treatment
    General principles 1282
    Neurally-mediated reflex syncopal syndromes 1283
    Orthostatic hypotension 1285
    Cardiac arrhythmias as primary cause 1286
    Structural cardiac or cardiopulmonary disease 1289
    Vascular steal syndromes 1289
    Metabolic 1290

  • Part 4. Special issues in evaluating patients with syncope
    Need for hospitalization 1290
    Syncope in the older adult 1290
    Syncope in paediatric patients 1292
    Driving and syncope 1293
    Glossary of uncertain terms 1293
    Preamble
    Scope of the document
    The purpose of this document is to provide specific
    recommendations on the diagnostic evaluation and
    management of syncope. The document is divided into
    four parts: (1) classification, epidemiology and prognosis;
    (2) diagnosis; (3) treatment; and (4) special issues
    in evaluating patients with syncope. Each part reviews
    background information and summarizes the relevant
    literature. The details of pathophysiology and mechanisms
    of various aetiologies were considered to lie
    outside the scope of this document. Although the document
    encompasses many of the important aspects of
    syncope, the panel recommendations focused on the
    following main questions:
    1. What are the diagnostic criteria for causes of
    syncope?
    2. What is the preferred approach to the diagnostic
    work-up in various subgroups of patients with
    syncope?
    3. How should patients with syncope be risk stratified?
    Correspondence: Michele Brignole, MD, FESC, Department of
    Cardiology and Arrhythmologic Centre, Ospedali Riuniti, 16033
    Lavagna, Italy.
    *This document has been reviewed by members of the Committee
    for Practice Guidelines (formerly Committee for Scientific and
    Clinical Initiatives) and by the members of the Board of the
    European Society of Cardiology (see Appendix 1), who approved
    the document on 8 March 2001. The full text of this document is
    available on the website of the European Society of Cardiology in
    the section ‘Scientific Information’, Guidelines.
    †For affiliations of Task Force members see Appendix 2.
    0195-668X/01/221256+51 $35.00/0  2001 The European Society of Cardiology
    4. When should patients with syncope be hospitalized?
    5. Which treatments are likely to be effective in preventing
    syncopal recurrences?
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