Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)
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Guidelines for the diagnosis
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The European Society of Cardiology guidelines do not address the ED management of syncope.
“For example, the European Society of Cardiology guidelines, which are the most inclusive syncope guidelines, do not address the ED management.”
From Syncope clinical management in the emergency department: a consensus from the first international workshop on syncope risk stratification in the emergency department (2016) · cites this paper as [7]
Section 5.2 is titled “Management of syncope in the Emergency Department” and describes ED risk stratification, including decisions about admission, discharge, and further testing. The guidelines therefore do address ED management of syncope. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe 2009 ESC guidelines recommend early use of ILRs in the diagnostic work-up of syncope.
“The updated versions of the guidelines highlight the use of implantable loop recorders (ILRs) and recommend their early use in the diagnostic work-up.”
From Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry (2011) · cites this paper as [8]
Section 2.2.3.8 supports considering ILRs early in the diagnostic work-up, but says this approach “might become” the reference standard when an arrhythmic cause is suspected but unproven. The citing sentence presents early use as a general recommendation, omitting that qualification and the guideline’s caution that monitoring depends on the initial evaluation. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe use of an insertable cardiac monitor (ICM) is strongly recommended by published practice guidelines for detecting infrequently but clinically important symptoms.
“The use of an insertable cardiac monitor (ICM) is now strongly recommended by published practice guidelines for detecting infrequently, but clinically important symptoms [1].”
From Ambulatory electrocardiogram monitoring devices for evaluating transient loss of consciousness or other related symptoms (2017) · cites this paper as [1]
Section 2.2.3.8 says an implantable loop recorder can be useful when arrhythmic syncope is suspected and may become a reference standard early in the work-up. Section 2.2.3.5 describes its prolonged recording capability. But the guideline does not broadly or strongly recommend it for infrequent symptoms; section 2.2.3.8 says monitoring may be unnecessary when apparently reflex syncope occurs only occasionally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the absence of associated jerky movements, patients with apparent loss of consciousness are likely to be referred for evaluation of syncope.
“In the absence of associated jerky movements, the patient is likely to be referred for evaluation of syncope (30,229,524).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [30]
The Epilepsy section says complete flaccidity during unconsciousness argues against epilepsy, so the absence of movements can help distinguish an episode from a seizure. But §2.1.1 bases syncope evaluation on the broader history of the episode, and §5.1 recommends referral when the diagnosis is uncertain and potentially dangerous—not simply when jerky movements are absent. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOnly a few of the recommendations from international syncope guidelines deal with ED management.
“Moreover, only a few of the recommendations from international syncope guidelines deal with ED management. 6-8”
The aetiology of POTS remains unknown.
“but its aetiology remains unknown.3–5”
From Antiadrenergic autoimmunity in postural tachycardia syndrome (2017) · cites this paper as [4]
POTS-related syncope differs from classic vasovagal syncope.
“POTS-related syncope differs from classic vasovagal syncope (VVS), as the underlying symptoms are present constantly with occasional syncope associated with a preceding tachycardia and associated adrenergic symptoms. In contrast, VVS typically features episodic syncope and asymptomatic periods between attacks.1,4,7”
From Antiadrenergic autoimmunity in postural tachycardia syndrome (2017) · cites this paper as [4]
A sensation of palpitation may stem from sinus tachycardia and/or increased cardiac contractility, both of which may have various causes: fever, anaemia, orthostatic hypotension, hyperthyroidism/thyreotoxicosis, postmenopausal syndrome, pregnancy, hypoglycaemia, hypovolaemia, pheochromocytoma, arteriovenous fistula, postural orthostatic tachycardia syndrome, among others.
“A sensation of palpitation may stem from sinus tachycardia and/or increased cardiac contractility, both of which may have various causes: fever, anaemia, orthostatic hypotension, hyperthyroidism/ thyreotoxicosis, postmenopausal syndrome, pregnancy, hypoglycaemia, hypovolaemia, pheochromocytoma, arteriovenous fistula, postural orthostatic tachycardia syndrome, among others.31 -39”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [38]
If heart rate exceeds 120-130 bpm during orthostatic stress, cardiac output becomes progressively compromised.
“However, if HR exceeds 120–130 bpm during orthostatic stress, cardiac output (CO) becomes progressively compromised234.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [234]
Another group of younger patients with IST caused by abnormalities of the If channel is tachycardic at rest which remains or increases due to sympathetic activation when upright.
“Another group of younger patients with IST caused by abnormalities of the If channel is tachycardic at rest which remains or increases due to sympathetic activation when upright.234.”
From Sinus Tachycardia: a Multidisciplinary Expert Focused Review (2022) · cites this paper as [234]
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Self-citationEpidemiology of reflex syncope
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Self-citationDiagnostic criteria for vasovagal syncope based on a quantitative history
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Safety and tolerability of Tilt Testing and Carotid Sinus Massage in the octogenarians
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Self-citationKey challenges in the current management of syncope
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- Authors
- Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), European Federation of Autonomic Societies (EFAS), American Autonomic Society (AAS), Authors/Task Force Members, Moya, A., Sutton, R., Ammirati, F., Blanc, J.-J., Brignole, M., Dahm, J. B., Deharo, J.-C., Gajek, J., Gjesdal, K., Krahn, A., Massin, M., Pepi, M., Pezawas, T., Granell, R. R., Sarasin, F., Ungar, A., van Dijk, J. G., Walma, E. P., Wieling, W., Contributors, E., Abe, H., Benditt, D. G., Decker, W. W., Grubb, B. P., Kaufmann, H., Morillo, C., Olshansky, B., Parry, S. W., Sheldon, R., Shen, W. K., ESC Committee for Practice Guidelines (CPG), Vahanian, A., Auricchio, A., Bax, J., Ceconi, C., Dean, V., Filippatos, G., Funck-Brentano, C., Hobbs, R., Kearney, P., McDonagh, T., McGregor, K., Popescu, B. A., Reiner, Z., Sechtem, U., Sirnes, P. A., Tendera, M., Vardas, P., Widimsky, P., Reviewers, D., Auricchio, A., Acarturk, E., Andreotti, F., Asteggiano, R., Bauersfeld, U., Bellou, A., Benetos, A., Brandt, J., Chung, M. K., Cortelli, P., Da Costa, A., Extramiana, F., Ferro, J., Gorenek, B., Hedman, A., Hirsch, R., Kaliska, G., Kenny, R. A., Kjeldsen, K. P., Lampert, R., Molgard, H., Paju, R., Puodziukynas, A., Raviele, A., Roman, P., Scherer, M., Schondorf, R., Sicari, R., Vanbrabant, P., Wolpert, C., & Zamorano, J. L.
- Affiliations
- University of Zurich (CH)
- Amsterdam Cardiovascular Sciences (NL)
- Rafael Advanced Defense Systems (Israel) (IL)
- St Mary's Hospital (GB)
- Vall d'Hebron Hospital Universitari (ES)
- ORCID
- Sutton, R.
- Ammirati, F.
- Brignole, M.
- Dahm, J. B.
- Deharo, J.-C.
- Gajek, J.
- Gjesdal, K.
- Krahn, A.
- Massin, M.
- Pepi, M.
- Pezawas, T.
- Sarasin, F.
- Ungar, A.
- Wieling, W.
- Abe, H.
- Benditt, D. G.
- Grubb, B. P.
- Kaufmann, H.
- Morillo, C.
- Olshansky, B.
- Parry, S. W.
- Sheldon, R.
- Shen, W. K.
- Vahanian, A.
- Bax, J.
- Ceconi, C.
- Filippatos, G.
- Hobbs, R.
- McDonagh, T.
- McGregor, K.
- Popescu, B. A.
- Sechtem, U.
- Sirnes, P. A.
- Tendera, M.
- Vardas, P.
- Andreotti, F.
- Asteggiano, R.
- Bellou, A.
- Benetos, A.
- Chung, M. K.
- Cortelli, P.
- Extramiana, F.
- Ferro, J.
- Kenny, R. A.
- Raviele, A.
- Scherer, M.
- Schondorf, R.
- Sicari, R.
- Vanbrabant, P.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-08-27
- Volume
- 30
- Issue
- 21
- Pages
- 2631-2671
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC3295536
- OpenAlex
- W2100661105
- Cited by
- 2,040
- References
- 226
- Citations by year
- 2026: 15 · 2025: 33 · 2024: 32 · 2023: 41 · 2022: 53 · 2021: 103 · 2020: 124 · 2019: 117 · 2018: 147 · 2017: 209 · 2016: 201 · 2015: 188 · 2014: 215 · 2013: 186 · 2012: 144
- FWCI
- 123.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Florence Research (University of Florence) (submittedVersion)
- Lithuanian University of Health Sciences (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Heart, Lung, and Blood Institute (R01HL090620)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- syncope, diagnosis, management, cardiovascular syncope, differential diagnosis
- MeSH terms
- Ambulatory Care, Continuity of Patient Care, Diagnostic Techniques, Neurological, Exercise Test, Humans, Quality of Life, Recurrence, Referral and Consultation, Risk Factors, Syncope, Prevalence, Cost of Illness, Age Distribution, Risk Assessment, Tilt-Table Test
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