Neurally mediated syncope: |
Absence of heart disease |
Long history of recurrent syncope |
After sudden unexpected unpleasant sight, sound, smell, or pain |
Prolonged standing or crowded, hot places |
Nausea, vomiting associated with syncope |
During a meal or postprandial |
With head rotation or pressure on carotid sinus (as in tumors, shaving, tight collars) |
After exertion |
Syncope due to OH: |
After standing up |
Temporal relationship with start or changes of dose of vasodepressive drugs leading to hypotension |
Prolonged standing, especially in crowded, hot places |
Presence of autonomic neuropathy or Parkinsonism |
Standing after exertion |
Cardiovascular syncope: |
Presence of definite structural heart disease |
Family history of unexplained sudden death or channelopathy |
During exertion or supine |
Abnormal ECG |
Sudden onset palpitation immediately followed by syncope |
ECG findings suggesting arrhythmic syncope: |
- Bifascicular block (defined as either LBBB or RBBB combined with left anterior or left posterior fascicular block)
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- Other intraventricluar conduction abnormalities (QRS duration ≥0.12 s)
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- Mobitz I second-degree AV block
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- Asymptomatic inappropriate sinus bradycardia (<50 bpm), sinoatrial block or sinus pause ≥3 s in the absence of negatively chronotropic medications
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- Long or short QT intervals
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- RBBB pattern with ST elevation in leads V1 to V3 (Brugada syndrome)
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- Negative T waves in right precordial leads, epsilon waves and ventricular late potentials suggestive of ARVC
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- Q waves suggesting myocardial infarction
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