Step 1 | History (key!!)

• 4 questions:
  • if all +: most likely syncope
    • Underlying mechanism?
    • Evidence to suggest a high risk?
      

Step 2 | ANAMNESIS is KEY

• Medical history | circumstances | start of TLOC | during TLOC |during the recovery from TLOC)
  • Some questions you may ask yourself
    • Have there been any previous episodes | medical history
    • Position of the patient: supine / standing / sitting
    • Was there specific circumstances (exercise, after standing,....)
    • Were there potential triggers
    • Were there any signs or symptoms before the fall (light-headedness, nausea, visual greying, sweating, palpitations..)
    • Were his eyes open or closed during the episodes
    • Was there any jerking of the limbs
    • Was he confused afterwards
    • ….

Step 3 | 12-lead ECG and office BP (supine and standing)

Step 4 | additional measures such as echo, Holter, …based on indication