Syncope has many possible causes, but the underlying mechanism of loss of consciousness is transient insufficiency of blood-flow to the brain. The result is a temporary disturbance of brain function causing loss of consciousness and collapse. By virtue of its being due to a self-limited hemodynamic problem resulting for example from a heart rhythm problem, or a drop in blood pressure of other cause, syncope differs from other conditions that cause loss of consciousness. A multidisciplinary approach is likely to be most effective for the evaluation and treatment of syncope; often the expertise of cardiologists, neurologists, emergency medicine specialists, general practitioners, geriatricians and other clinicians is needed. However, unfortunately, each of these sub-specialties have tended to develop and use different terminology, methodology and management guidelines; this has complicated effective interaction among these various care-givers, and has made evaluation and treatment of affected patients more complex. This volume, represents a thorough multidisciplinary review of the subject, offering recommendations based on the guidelines as well as experience derived from the various sub-specialties. It begins by discussing the scientific basis behind the diverse pathophysiology of conditions that may cause syncope, and reviews the optimal clinical management pathways. Later sections of the book then take a more practical approach, defining recommendations for the practice of syncope management through case examples. The most common procedures and tests are discussed along with their indications, methodology, interpretation, and limitations. This book has been designed to fulfill the needs of the wide range of medical practitioners involved in the care of syncope patients. All specialties will benefit from the concentration on the importance of medical history taking. Emergency room physicians and internists will be aided by the focus on risk stratification. Cardiologists and cardiac electrophysiologists will find up-to-date recommendations regarding the indications for and appropriate interpretation of noninvasive and invasive cardiac testing. Neurologists and psychiatrists will find useful the sections exploring the often difficult topic of distinguishing true syncope from other important conditions that may present as transient loss of consciousness.

Zusammenfassung
Syncope represents a multidisciplinary issue in medicine, often involving cardiologists, neurologists, emergency medicine specialists, general practitioners , geriatricians and other clinicians. However, terminology, methodology and guidelines differ making the issue more complex. The Editors of this book present a thorough multidisciplinary review of the topic. Guideline-based, they have assembled a team of key opinion leaders in the study and management of syncope. The first section of the book discusses the scientific basis behind the diagnosis and management of syncope going into detail regarding the pathways leading to syncope symptoms and the pathology behind them. The second section of the book then takes a more practical approach defining the practice of syncope management and including a number of case histories explaining the pearls and pitfalls of the current guidelines.

Inhalt
SECTION ONE A Current evidence-based knowledge: Classification, Pathophysiology and Social / Economic Impact.- Chapter 1. Syncope: definition, terminology, and classification.- 1.1 Definition.- 1.1.1 Loss of consciousness.- 1.1.2 Onset is relatively rapid.- 1.1.3. Recovery is spontaneous, complete and usually prompt.- 1.1.4. Underlying mechanism is transient global cerebral hypoperfusion.- 1.2. Terminology.- 1.3. Classification.- 1.3.1 Neurally-Mediated Reflex Syncope.- 1.3.2 Orthostatic (Postural) Syncope.- 1.3.3 Cardiac (Cardiovascular) Syncope.- 1.4. Conclusion.- Chapter 2. Pathophysiology of syncope.- 2.1 Maintenance of Adequate Cerebral Blood Flow.- 2.1.1 Autonomic Neural Control.- 2.1.2 Cerebrovascular Autoregulation.- 2.2 Failure to Maintain Cerebrovascular Perfusion.- 2.2.1 Neurally-mediated cerebral hypoperfusion.- 2.2.2 Non-neurally-mediated causes of hypotension.- 2.3 Clinical perspectives.- Chapter 3. Epidemiology of syncope (fainting).- 3.1 Prevalence and Incidence.- 3.1.1 Community-based estimates.- 3.1.2 Selected population estimates.- 3.2 Syncope recurrences.- 3.3 Mortality Concerns.- 3.4 Unresolved Prognostic Issues.- 3.5 Clinical Perspectives.- Chapter 4 Syncope burden: economic impact of syncope on healthcare resources and personal well-being.- 4.1 Cost of TLOC/Syncope Care.- 4.1.1 Current Status.- 4.1.2 Opportunity for Reducing Cost.- 4.2 Quality of life.- 4.3 Clinical perspectives.- SECTION ONE B Current evidence-based knowledge: Structured Diagnostic Strategy.- Chapter 5. The initial evaluation of T-LOC: diagnostic strategy based on the initial findings.- 5.1 The Initial evaluation.- 5.1.1 History and physical examination.- 5.1.2 Baseline electrocardiogram.- 5.1.3 Additional tests.- 5.2 The 3 main question to be addressed at initial evaluation.- 5.2.1 Is loss of consciousness attributable to syncope or not?.- 5.2.2. Is heart disease present or absent?.- 5.2.3. Is there features in the history that suggest the diagnosis?.- 5.3 Thediagnostic strategy based on the initial evaluation.- 5.3.1 Certain diagnosis.- 5.3.2 Uncertain diagnosis.- 5.4 Diagnostic yield of the initial evaluation.- 5.5 Clinical perspectives.- Chapter 6. T-LOC Risk stratification.- 6.1 Introduction.- 6.2 Assessing the risk.- 6.2.1 Risk of death and life-threatening events.- 6.2.2 Risk of syncope recurrence.- 6.3 Management according to risk stratification.- 6.4 Clinical perspectives: in-hospital versus out-patient evaluation in specialized facilities.- Chapter 7. Indications for and interpretation of laboratory diagnostic tests.- 7.1 Introduction.- 7.2 Carotid sinus massage.- 7.2.1 Indications.- 7.2.2 Interpretation of results.- 7.3 Orthostatic challenge (Active Standing Test and Tilt-table Testing).- 7.3.1 Active Standing Test.- 7.3.2 Tilt-table testing.- 7.4 ATP (Adenosine) test.- 7.4.1 Indications.- 7.4.2 Interpretation of results.- 7.5 Electrophysiological study.- 7.5.1 Suspected sinus node disease (SND).- 7.5.2 Bundle Branch Block.- 7.5.3 Suspected supraventricular tachycardia.- 7.5.4 Suspected ventricular tachycardia.- 7.5.5 Indications.- 7.5.6 Interpretation of results.- 7.6.1 Indications.- 7.6.2 Interpretation of results.- 7.7 Other tests.- 7.8 Diagnostic yield of laboratory tests in patients with uncertain syncope.- 7.9 Clinical perspectives.- Chapter 8. Prolonged Ambulatory ECG diagnostic monitoring ...current and evolving indications.- 8.1 Introduction.- 8.2 Interpretation of results.- 8.3 In-hospital monitoring.- 8.3.1 Indications.- 8.4 Holter monitoring.- 8.5 External loop recorder (ELR) and remote at-home telemetry.- 8.5.1 Indications.- 8.6 Implantable loop recorder (ILR).- 8.6.1 Natural history of syncope (probability of recurrence of syncope) in patients at low risk.- 8.6.2 Value of ILR in diagnosis of syncope.- 8.6.3 ILR in syncope where in the workup?.- 8.6.4 Indications.- 8.6.5 Classification of responses.- 8.5.7 Therapy guided by ILR.- 8.5.8 Technical aspects.- 8.6 Diagnostic yield of prolongeddiagnostic monitoring in patients with uncertain syncope.- 8.7 Clinical perspectives.- Chapter 9. Syncope facilities: background and current standard.- 9.1 Background: why should we need a dedicated facility?.- 9.2 Some existing syncope facility models.- 9.2.1 Newcastle.- 9.2.2 Manchester.- 9.2.3 Controlled studies of patients presenting with syncope to the Emergency Department.- 9.3 The standards recommended by the ESC guidelines.- 9.3.1. Referral.- 9.3.2. Objectives.- 9.3.3. Professional skill mix for the Syncope Unit.- 9.3.4. Equipment.- 9.4 Clinical perspectives.- Chp 10.- Syncope (T-LOC) Management Units: the Italian model.- 10.1 Introduction.- 10.2 The Italian Syncope Manag…