Syncope: A focused approach to the workup and management

Allison B. Ludwig, Sreekanth Vemulapalli, Nora Goldschlager

Research output: Contribution to journalReview articlepeer-review


Structural heart disease is the most important risk factor for mortality in patients with syncope. A workup that includes a thorough history taking, focused physical examination, and electrocardiography yields a diagnosis in nearly half of cases. Echocardiography is indicated in patients with syncope who have a history of cardiac abnormality, abnormal ECG findings, or unexplained syncope. Tilt-table testing and the implantable loop recorder are useful in patients with recurrent syncope of unclear origin. α-Agonists and selective serotonin reuptake inhibitors are the most effective agents for treating neurocardiogenic syncope. Patients with orthostatic syncope require aggressive hydration and a workup for autonomic insufficiency and, in selected patients, adrenal insufficiency. Implantable cardioverter-defibrillators are indicated in specific forms of cardiogenic syncope. Refer patients with unexplained syncope and suspected structural heart disease and/or negative tilt-table testing and/or abnormal findings on implanted loop recording to a specialist.

Original languageEnglish (US)
Pages (from-to)717-723
Number of pages7
Issue number7
StatePublished - Jun 1 2006
Externally publishedYes


  • Electrocardiography
  • Fainting
  • Orthostatic hypotension
  • Syncope
  • Tilt-table test

ASJC Scopus subject areas

  • Medicine(all)


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