ESC TV Today – Your Cardiovascular News Season 3 - Ep.15 : Extended interview on An algorithmic approach to the workup of syncope
May 8, 2025
In this intriguing discussion, Professor Michele Brignole, a distinguished expert on syncope from Italy, shares his insights on the evaluation and management of this puzzling condition. He highlights a standardized three-stage diagnostic approach and the importance of differentiating cardiac causes. The conversation dives into diagnostic strategies for unexplained syncope, emphasizing advanced monitoring techniques, especially for elderly patients. Listeners will learn about the significance of blood pressure variations and innovative methods like ambulatory monitoring.
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Syncope Causes Vary by Age
- The causes of syncope vary widely with the patient's age and structural disease presence.
- Younger patients mostly face autonomic causes; elderly often experience loss of compensatory mechanisms like orthostatic hypotension.
Three-Stage Syncope Workup
- Use a three-stage standardized evaluation for autonomic syncope: initial evaluation, laboratory testing, and implantable loop recorder if needed.
- The initial stage with history, exam, and ECG diagnoses about half, and further tests safely reproduce syncopal mechanisms.
Approach to Cardiac Syncope Tests
- Use Holter monitoring for frequent syncope and implantable loop recorders for rare episodes.
- Reserve electrophysiology studies for clear indications like bifascicular block, old myocardial infarction, or suspected sick sinus syndrome.