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Practice Guideline
. 2009 Nov;30(21):2631-71.
doi: 10.1093/eurheartj/ehp298. Epub 2009 Aug 27.

Guidelines for the diagnosis and management of syncope (version 2009)

Task Force for the Diagnosis and Management of Syncope; European Society of Cardiology (ESC); European Heart Rhythm Association (EHRA); Heart Failure Association (HFA); Heart Rhythm Society (HRS); Angel Moya, Richard Sutton, Fabrizio Ammirati, Jean-Jacques Blanc, Michele Brignole, Johannes B Dahm, Jean-Claude Deharo, Jacek Gajek, Knut Gjesdal, Andrew Krahn, Martial Massin, Mauro Pepi, Thomas Pezawas, Ricardo Ruiz Granell, Francois Sarasin, Andrea Ungar, J Gert van Dijk, Edmond P Walma, Wouter Wieling
Collaborators
Practice Guideline

Guidelines for the diagnosis and management of syncope (version 2009)

Task Force for the Diagnosis and Management of Syncope et al. Eur Heart J. 2009 Nov.
No abstract available

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Figures

Figure 1
Figure 1
Context of transient loss of consciousness (T-LOC). SCD = sudden cardiac death.
Figure 2
Figure 2
Pathophysiological basis of the classification (see text). ANF = autonomic nervous failure; ANS = autonomic nervous system; BP = blood pressure; low periph. resist. = low peripheral resistance; OH = orthostatic hypotension.
Figure 3
Figure 3
A case of ‘initial orthostatic hypotension’ (left panel) and of ‘classical orthostatic hypotension’ (right panel). In the left panel obtained in an otherwise healthy 17-year-old teenager with complaints of severe transient lightheadedness upon active standing, a pronounced initial fall in BP is observed. The nadir is at 7–10 s and followed by recovery of BP. The tracing on the right is obtained in a 47-year-old male with pure ANF. BP starts to fall immediately after standing to very low levels after 1 min upright with little increase in HR despite the hypotension., ANF = autonomic failure; BP = blood pressure; HR = heart rate; b.p.m. = beats per minute.
Figure 4
Figure 4
Reflex syncope (mixed form) induced by tilt testing in a 31-year-old (upper panel) and in a 69-year-old patient (lower panel). Note the typical age differences with a much steeper fall in BP in the younger subject compared with the older subject (revised after Verheyden et al.). BP = blood pressure; HR = heart rate; b.p.m. = beats per minute.
Figure 5
Figure 5
Schematic presentation of the distribution of age and cumulative incidence of first episode of syncope in the general population from subjects up to 80 years is shown. The data from subjects 5–60 years come from a study by Ganzeboom et al. The data from subjects <5 years are based on those of Lombroso et al. and those from subjects aged 60–80 years on the study by Soteriades et al.
Figure 6
Figure 6
Syncope events/visits per 1000 patient-years in The Netherlands (from Ganzeboom et al. with permission). ED = Emergency Department.
Figure 7
Figure 7
Diagnostic flowchart in patients with suspected T-LOC. ECG = electrocardiographic; T-LOC = transient loss of consciousness.
Figure 8
Figure 8
Treatment of syncope. ARVC = arrythmogenic right ventricular cardiomyopathy; CAD = coronary artery disease; DCM = dilated cardiomyopathy; ECG = electrocardiographic; HOCM = hypertrophic obstructive cardiomyopathy; ICD = implantable cardioverter defibrillator; SCD = sudden cardiac death.
See this image and copyright information in PMC

References

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    1. Thijs RD, Benditt DG, Mathias CJ, Schondorf R, Sutton R, Wieling W, van Dijk JG. Unconscious confusion—a literature search for definitions of syncope and related disorders. Clin Auton Res. 2005;15:35–39. - PubMed
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    1. Hoefnagels WA, Padberg GW, Overweg J, van der Velde EA, Roos RA. Transient loss of consciousness: the value of the history for distinguishing seizure from syncope. J Neurol. 1991;238:39–43. - PubMed

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