Assessment strategies

International guidelines recommend the following diagnostic pathway for the assessment of syncope:

The strategy for subsequent assessment of patients in whom the initial evaluation resulted in no known diagnosis varies:

In patients with structural heart disease or who have an abnormal ECG, cardiac evaluation consisting of echocardiography, stress testing and ECG monitoring or electrophysiologic studies are recommended.

In patients where neurally-mediated syncope is suspected after the initial evaluation or if cardiac evaluation does not show evidence of arrhythmia, structural heart disease or abnormal ECG as a cause of syncope, evaluation for neurally-mediated syndromes is recommended in those with recurrent or severe syncope.