Approach to the Pt with Syncope - Flowchart
Approach to the Pt with Syncope - Flowchart
«Flowchart»

Syncope

Syncope

Syncope

Normal history and physical examination

Normal history and physical examination

Normal

History, physical exam, ECG suggest cardiac disease

History, physical exam, ECG suggest cardiac disease

History

Examination reveals orthostatic hypotension

Examination reveals orthostatic hypotension

Examination

Review medication

Review medication

Review

Reflex syncope

Reflex syncope

Reflex syncope

Tilt testing if severe or recurrent

Tilt testing if severe or recurrent

Tilt testing if severe or recurrent

Echocardiogram, 24-hr Holter monitor, stress test, other cardiac testing as indicated

Echocardiogram, 24-hr Holter monitor, stress test, other cardiac testing as indicated

Echocardiogram, 24-hr Holter monitor, stress test, other cardiac testing as indicated

Consider postganglionic autonomic insufficiency

Consider postganglionic autonomic insufficiency

Consider postganglionic autonomic insufficiency

End

End

End

Normal neurologic exam

Normal neurologic exam

Normal

Abnormal neurologic exam

Abnormal neurologic exam

Abnormal

Peripheral neuropathy (consider diabetic, nutritional, amyloid, etc.)

Peripheral neuropathy (consider diabetic, nutritional, amyloid, etc.)

Peripheral

Central nervous system findings
Consider multiple system atrophy

Central nervous system findings
Consider multiple system atrophy


Central