Ammirati et al reported an approach for the diagnosis of syncope. This can reduce the number of patients with unknown cause. The authors are from multiple institutions participating in the OESIL 2 study (Osservatorio Epidemiologico dell Sincope nel Lazio).

Patient selection: syncope


Diagnostic approach:

(1) initial assessment with history, physical exam, ECG, hemoglobin and blood glucose

(2) targeted assessments for cardiac, neurally-mediated or neuropsychiatric syncope


Syncope Type



echocardiogram; exercise testing or Holter monitoring if needed


carotid sinus massage; head-up tilt test


EEG, CT scan, carotid artery echo Doppler; psychiatric evaluation if needed


If the workup for one syncope type was negative, then the other types are considered.


Criteria for syncope of unknown origin - all of the following:

(1) negative first step assessment

(2) no clinical or laboratory evidence of cardiac, neurological or psychiatric disease that explains syncope

(3) negative carotid sinus massage and head-up tilt-testing

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