Syncope Evaluation (ESC 2018)
Syncope Evaluation (ESC 2018): Syncope Episode → Initial Evaluation → Diagnosis Certain? → Treat Accordingly.
Interactive Decision Tree
Algorithm Steps
- ▶Start
Syncope Episode
Transient loss of consciousness
- ●Action
Initial Evaluation
History, exam, ECG, orthostatics
- Detailed history (patient + witness)
- Physical examination
- 12-lead ECG
- Supine and standing BP
- ◆Decision
Diagnosis Certain?
Can etiology be determined?
If Yes:
- ✓Outcome
Treat Accordingly
Manage identified cause
If No:
- ◆Decision
Risk Stratification
Assess for high-risk features
- ●Action
Low Risk
Outpatient management
- No cardiac history
- Normal ECG
- Typical reflex features
- Situational triggers
- ✓Outcome
Reflex Syncope
Education, hydration, countermeasures
- ●Action
Uncertain Risk
Syncope Unit evaluation
- Neither clearly high nor low risk
- Expedited outpatient workup
- Holter/event monitor
- ✓Outcome
Unexplained
ILR consideration if recurrent
- ●Action
High Risk
Admit for evaluation
- Continuous ECG monitoring
- Echocardiography
- Consider EP study
- Risk assessment scores
- ✓Outcome
Cardiac Syncope
Treat underlying cause, consider device
- ⚠Warning
High Risk Features
Require admission/urgent workup
- Structural heart disease
- Abnormal ECG
- Syncope during exertion
- Syncope while supine
- Family Hx sudden death
- Severe anemia
Guideline Source
2018 ESC Guidelines for the Diagnosis and Management of Syncope
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- 2018 guidelines - pending ESC update
- Does not replace clinical judgment for risk stratification
- Cardiac syncope workup simplified
Contraindicated Populations
Applicable Regions
EU: ESC 2018 - EGSYS score not better than clinical judgment
US: San Francisco Syncope Rule not recommended by ESC
Next steps
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Related Resources
Frequently Asked Questions
What is the Syncope Evaluation (ESC 2018)?
The Syncope Evaluation (ESC 2018) is a diagnostic clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2018 ESC Guidelines for the Diagnosis and Management of Syncope.
What guideline is the Syncope Evaluation (ESC 2018) based on?
This algorithm is based on 2018 ESC Guidelines for the Diagnosis and Management of Syncope (DOI: 10.1093/eurheartj/ehy037).
What are the limitations of the Syncope Evaluation (ESC 2018)?
Known limitations include: 2018 guidelines - pending ESC update; Does not replace clinical judgment for risk stratification; Cardiac syncope workup simplified. Individual patient factors may require deviation from these recommendations.
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