FOCUS on Syncope

Syncope is a common cause of cardiological consultation, accounting for 1-3% of all emergency department visits and up to 5% of hospital admissions in cardiology wards. Aetiology of syncope is multifactorial. Reflex (vasovagal) syncope accounts for 40-50% of all cases, while orthostatic hypotension is responsible for 20-30%, particularly in older adults. Cardiac causes, including arrhythmias and structural heart disease, are less common but more concerning due to their poorer prognosis. Diagnostic strategy involves structured risk stratification, including orthostatic blood pressure measurement, ECG interpretation, and targeted use of advanced diagnostic tools such as cardiac imaging, tilt testing, ILR implantation and electrophysiologic evaluation. Management of syncope is aetiology-specific, with reflex syncope typically requiring only lifestyle modifications, while other causes may necessitate intervention including but not only pacemaker or ICD implantation. Explore the FOCUS resources to learn more about syncope.