Medical Diagnosis

In the evaluation of patients with syncope, the critical first step is a detailed medical history. A diagnostic strategy based on initial evaluation is warranted. The importance of the initial evaluation goes well beyond its capability to make a diagnosis as it determines the most appropriate subsequent diagnostic pathways and risk evaluation.

THE DIAGNOSTIC STRATEGY BASED ON THE INITIAL EVALUATION

According to the Guidelines on Syncope of the European Society of Cardiology (ESC)1,2the “initial evaluation” of a patient presenting with syncope consists of taking a careful history, and a physical examination, including orthostatic blood pressure measurements and standard electrocardiogram (ECG).

Three key questions should be addressed during the initial evaluation:

• Is loss of consciousness attributable to syncope or not? Differentiating true syncope from “non‐syncopal” conditions associated with real or apparent transient loss of consciousness is generally the first diagnostic challenge and influences the subsequent diagnostic strategy....