An integrated approach to syncope in the context of transient loss of consciousness

Abstract

This thesis focuses on improving the diagnosis and management of syncope by exploring clinical features, physiological mechanisms, and implementation strategies in healthcare settings.

Part I: Clinical and Physiological Aspects of Syncope

Chapter 1 outlines the semiology of syncope and its distinction from other forms of transient loss of consciousness. Chapter 2 analyzes sex differences in tilt table testing: men fainted more without the use of nitroglycerin, while women fainted more after administration of nitroglycerin, possibly due to differences in body composition and venous blood pooling. Chapter 3 introduces three diagnostic hemodynamic features—blood pressure drop latency, the shape of the blood pressure curve, and the heart rate response—which help accurately distinguish vasovagal syncope from classical orthostatic hypotension. Part II: Syncope Care in the Emergency Department Part II evaluates syncope care through the SYNERGY study (Chapter 4), which showed that implementing the 2018 European Society of Cardiology Syncope Guidelines with rapid referral to a specialized Syncope Unit improved diagnostic accuracy and reduced societal costs. Chapter 5, a qualitative study, identified key barriers such as time pressure and limited knowledge, and facilitators such as structured workflows and interprofessional collaboration. Overall, this thesis highlights both clinical and organizational strategies to enhance syncope diagnosis and care delivery.