Low-risk factors | High-risk factors |
Characteristics of the patients |
Young age (<40 years) | |
Characteristics of syncope |
Only while standing | During exertion |
Standing from supine/sitting position | In supine position |
Nausea/vomiting before syncope | New onset chest discomfort |
Feeling of warmth before syncope | Palpitations before syncope |
Triggered by painful/emotionally distressing stimulus | Associated with dyspnea |
Triggered by cough/defecation/micturition | |
Factors present in the history of the patient |
Prolonged history (years) of syncope with same characteristics as current episode | Family history of sudden death |
| Decompensated (congestive) heart failure |
| Aortic stenosis |
| Left ventricular outflow tract disease |
| Dilated cardiomyopathy |
| Hypertrophic cardiomyopathy |
| Arrhythmogenic right ventricular cardiomyopathy |
| Left ventricular ejection fraction <35% |
| Documented ventricular arrhythmia |
| Coronary artery disease/Myocardial infarction |
| Congenital heart disease |
| Pulmonary hypertension |
| ICD implantation |
Symptoms, signs, or variables associated with the syncopal episode |
| Anemia (Hb <9 g/dL) |
| Lowest systolic blood pressure in the emergency department <90 mmHg |
| Sinus bradycardia (<40 bpm) |
ECG features* |
| New (or previously unknown) left bundle branch block |
| Bifascicular block + first degree AV block |
| Brugada ECG pattern |
| ECG changes consistent with acute ischemia |
| Non-sinus rhythm (new) |
| Bifascicular block |
| Prolonged QTc (>450 ms) |