Syncope Emergency Workup

Syncope is a transient loss of consciousness caused by global cerebral hypoperfusion, with rapid onset, short duration, and spontaneous complete recovery. It is a symptom, not a final diagnosis. Reflex syncope and orthostatic hypotension are common mechanisms, but the emergency assessment must first look for an arrhythmia, structural heart disease, hemorrhage, pulmonary embolism, myocardial ischemia, or another serious cause. [1,2] The assessment purpose is to confirm that the event fits syncope, identify a serious cause that is already apparent, and estimate the risk of a serious outcome when the cause remains uncertain. A careful history, physical examination with supine and standing blood pressure when safe, and a standard 12-lead ECG form the initial evaluation. Additional tests answer questions raised by those findings rather than constituting a routine panel. [1,2] The Canadian Syncope Risk Score (CSRS) is an adjunct after the emergency assessment, not a substitute for it. It estimates the risk of a serious outcome within 30 days when no serious cause has already been identified. Newer external validation found more modest performance than the original Canadian validation, reinforcing that...