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) |
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