Syncope referral checklist

Urgency tier

• Syncope during exertion or while supine.
• Chest pain, palpitations, or family history of sudden death.
• Abnormal ECG or known structural heart disease.
• Significant injury or prolonged altered consciousness.
• Persistent neurologic deficits after the event.

Minimum pre-referral workup

• Detailed event description, prodrome, and recovery.
• Orthostatic vital signs and cardiovascular exam.
• Resting ECG with interpretation.
• Review medications and recent changes.
• Point-of-care glucose and basic labs if indicated.

Referral packet checklist

• Circumstances, triggers, and witness account.
• Orthostatic measurements and ECG findings.
• Medication list, substance use, and comorbidities.
• Prior episodes or known arrhythmias.
• Any ED visits or investigations already completed.

Pre-referral optimization tasks

• Address reversible contributors such as dehydration or medication effects where appropriate.
• Provide safety advice on activity and driving restrictions per local guidance when needed.
• Reinforce return precautions for recurrent syncope, chest pain, or new neurologic deficits.

References

• Canadian Cardiovascular Society Syncope (Drive 2023) (opens in a new tab)

Something out of date or unclear? Suggest an update. Leave out any patient details.