title: [Evaluation of "complex syncope: what are the indications for second-level investigations?].
abstract: Syncope is a common symptom accounting for 1.1% of all admissions to the emergency department in Italy. Diagnostic and therapeutic management of patients with syncope may be complex and with a major impact on health expenditure. A standardized approach to syncope may reduce diagnostic tests, hospitalizations and health costs. After the initial "gold standard" evaluation, which includes history, physical examination, orthostatic hypotension test and ECG, several diagnostic pathways can be followed. It has been shown that a correct initial evaluation and a thorough knowledge of syncope can reduce needless testing and increase diagnostic yield, optimizing resource management. In this review we aim to underscore the key points of the management of patients with syncope and the main indications for specific second-level examinations, such as those for neuroautonomic evaluation (tilt table test, carotid sinus massage) and implantable loop recorder. The role of Syncope Units in the management of patients with temporary loss of consciousness is also described.
authors.affiliation: Centro per lo Studio della Sincope, Cardiologia e Medicina Geriatrica, Università degli Studi, Azienda Ospedaliero-Universitaria Careggi, Firenze.rdiologia, Azienda USL 11, Empoli (FI) aungar@unifi.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Ungar
authors.forename: Alessandro
authors.initials: A
authors.lastname: Morrione
authors.forename: Martina
authors.initials: M
authors.lastname: Rafanelli
authors.forename: Alice
authors.initials: A
authors.lastname: Maraviglia
authors.forename: Annalisa
authors.initials: A
authors.lastname: Landi
authors.forename: Francesca
authors.initials: F
authors.lastname: Caldi
authors.forename: Valentina Maddalena
authors.initials: VM
authors.lastname: Chisciotti
authors.forename: Emilia
authors.initials: E
authors.lastname: Ruffolo
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Attilio
authors.initials: A
authors.lastname: Del Rosso
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D002986:Clinical Trials as Topic; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004594:Electrophysiology; D004827:Epilepsy / Q000175:diagnosis; D005260:Female; D006757:Hospital Units; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013902:Radiography, Thoracic; D013575:Syncope / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D018667:Tilt-Table Test