Syncope and sudden cardiac death: some answers to clinical challenges

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![][1] Sudden loss of consciousness is a dramatic and potentially lethal event. Unfortunately, the optimal evaluation of syncope remains controversial. Current practice varies considerably among different countries, and potential benefits of extensive evaluations and the high costs involved are often put into context with the questionable clinical benefit of such approaches. Although history taking has been standardized,1 only a few of the recommendations from international syncope guidelines deal specifically with appropriate measures in the emergency setting. For example, the different European Society of Cardiology guidelines referring to various causes of syncope2–5 do not address this issue. This could be due to limited evidence on how to stratify the risk and decide on the disposition of such patients in the emergency setting. Therefore the Current Opinion ‘Syncope clinical management in the emergency department: a consensus from the first international workshop on syncope risk stratification in the emergency department’ by Giorgio Costantino from the Ospedale Maggiore Policlinico in Milano, Italy6 is a timely contribution to the existing literature. The document represents a consensus paper of experts in the field who provide a four-step conceptual model for the emergency department decision-making in syncope. (i) Is it syncope? (ii) Is there a serious underlying condition identified in the emergency department? (iii) If the cause is uncertain, what is the risk of a serious outcome? (iv) For a given risk profile, how can these patients be best managed in the emergency department and what evaluation and restrictions are required? In spite of all the uncertainties in the acute management of syncope, this approach may help to improve risk stratification and later management of patients with sudden loss of consciousness. Not all patients with syncope reach an emergency unit: many … [1]: /embed/graphic-1.gif