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CardiologyDiagnostic

Syncope Evaluation (ESC 2018)

Syncope Evaluation (ESC 2018): Syncope Episode → Initial Evaluation → Diagnosis Certain? → Treat Accordingly.

Pathway Overview

12 steps

Algorithm Steps

12 total

  1. 01Start

    Syncope Episode

    Transient loss of consciousness

  2. 02Action

    Initial Evaluation

    History, exam, ECG, orthostatics

    • Detailed history (patient + witness)
    • Physical examination
    • 12-lead ECG
    • Supine and standing BP
  3. 03Decision

    Diagnosis Certain?

    Can etiology be determined?

  4. If Yes
    1. 04Outcome

      Treat Accordingly

      Manage identified cause

    If No
    1. 05Decision

      Risk Stratification

      Assess for high-risk features

    2. 06Action

      Low Risk

      Outpatient management

      • No cardiac history
      • Normal ECG
      • Typical reflex features
      • Situational triggers
    3. 07Outcome

      Reflex Syncope

      Education, hydration, countermeasures

    4. 08Action

      Uncertain Risk

      Syncope Unit evaluation

      • Neither clearly high nor low risk
      • Expedited outpatient workup
      • Holter/event monitor
    5. 09Outcome

      Unexplained

      ILR consideration if recurrent

    6. 10Action

      High Risk

      Admit for evaluation

      • Continuous ECG monitoring
      • Echocardiography
      • Consider EP study
      • Risk assessment scores
    7. 11Outcome

      Cardiac Syncope

      Treat underlying cause, consider device

    8. 12Warning

      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

DOI: 10.1093/eurheartj/ehy037View Guideline

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

pediatric

Applicable Regions

EUUS

EU: ESC 2018 - EGSYS score not better than clinical judgment

US: San Francisco Syncope Rule not recommended by ESC

Version 1Next review: 2026-06-01

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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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