Syncope is a transient loss of consciousness; an event that can leave those affected in the confusion or be a warning sign for serious, life-threatening disorders. This is not uncommon, since almost half of the population experiences syncope once in a lifetime.

It is therefore essential that in front of a patient with syncope, the First Aid doctor has the right tools to quickly distinguish the gravity of the situation and treat it accordingly. This need has been met by the new 2018 guidelines for the diagnosis and management of syncope, recently published by the European Society of Cardiology (ESC) in the magazine European Heart Journal.


The role of Humanitas in the drafting of the guidelines

The previous edition dates back to 2009 and the foundations of the new guidelines were laid by Humanitas in 2013, thanks to the organization of an international conference on the management of syncope in which the world’s leading experts took part. The specialists drew from the discussion two important so-called scientific works of consensus, containing the conclusions they shared, which then provided the framework for the new guidelines on the problem of risk stratification.

Both works were coordinated by Professor Raffaello Furlan, Head of the Medical Clinic at Humanitas and Professor at Humanitas University.


Risk stratification

As Prof. Furlan explains: “The first, very important novelty of these guidelines is precisely the stratification of risk: patients at low risk, to be discharged in peace, are immediately distinguished from those at intermediate and high risk, who are no longer automatically hospitalized as before, but followed further with a monitoring for 24-48 hours and, depending on the elements emerged, possibly discharged in a protected way, that is with controls arranged 5-7 days after the event, as an alternative to hospitalization, which is however tiring for the patient and aims to limit to cases where it is strictly necessary”.

It is therefore a matter of diagnosing and managing syncope with precision, without overestimating it, so as not to force admission or expose the patient to too many useless investigations, nor underestimating it, understanding clearly when it can lead to death.


The role of the autonomic nervous system

“There is a second key element that is absolutely new, represented by the transposition of the central role of the autonomic nervous system, as regulator of the good functioning of the heart and of the arterial vessels in the problem of syncope. So much so that for the first time the ESC guidelines prescribe different tests on sympathetic nervous activity, tests that we have been doing for a long time,” continues Professor Furlan.

This second element reflects the versatility of syncope: whether it is a symptom or an episode, its genesis is complex and varied. The team of specialists that drew up the new guidelines are in fact highly multidisciplinary: in addition to cardiologists, the team includes electro-physiologists, neurologists, internists, geriatricians and doctors who work in emergencies.

In fact, a third chapter of the guidelines, already mentioned in the previous version but now more valued, concerns the importance of syncopation Units and underlines the need for a functional transversal organization that is a true multi-specialist team, such as the one active in Humanitas that sees the direct contribution of Dr. Franca Barbic, Dr. Franca Dipaola and Dr. Maura Minonzio.