Syncope is a common and serious diagnostic dilemma. A structured and systematic approach to assessment and management will help ensure that serious and treatable causes are not overlooked.
- Syncope is not a diagnosis in and of itself.
- In one-third of syncopal cases a cause is not found, in one-third the cause is benign, and in one-third there is a serious underlying cause.
- A diagnosis can be made in 50% of patients on history, examination and ECG alone.
- The clinician should aim to exclude serious causes of syncope and treat other causes as appropriate.
- Management can often be achieved through noninterventional means.
- An holistic approach is required for elderly patients with syncope.