Canadian Cardiovascular Society Clinical Practice Update on the Assessment and Management of Syncope

Syncope is a symptom that occurs in multiple settings and has a va-riety of underlying causes, ranging from benign to life threatening. Determining the underlying diagnosis and prognosis can be chal-lenging and often results in an unstructured approach to evaluation, which is ineffective and costly. In this first ever document, the Cana-dian Cardiovascular Society (CCS) provides a clinical practice update on the assessment and management of syncope. It highlights simi-larities and differences between the 2017 American College of Car-diology/American Heart Association/Heart Rhythm Society and the 2018 European Society of Cardiology guidelines, draws on new data following a thorough review of medical literature, and takes the best available evidence and clinical experience to provide clinical practice tips. Where appropriate, a focus on a Canadian perspective is emphasized in order to illuminate larger international issues. This document represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific advice. The primary writing panel wrote the document, followed by peer review from the secondary writing panel. The CCS Guidelines Committee reviewed and approved the statement. The practice tips represent the consensus opinion of the primary writing panel authors, endorsed by the CCS. The CCS clinical practice update on the assessment and management of syncope focuses on epide-miology, the initial evaluation including risk stratification and disposi-tion from the emergency department, initial diagnostic work-up, management of vasovagal syncope and orthostatic hypotension, and syncope and driving.