Skip links and keyboard navigation

Syncope / pre-syncope (Cardiology)


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • New episode(s) of uninvestigated syncope / near syncope without any of the following concerning features
      • exertional onset
      • chest pain
      • persistent hypotension (systolic BP <90mmHg)
      • severe persistent headache
      • focal neurological deficits
      • preceded by or associated with palpitations
      • known ischaemic heart disease or reduced LV systolic function
      • associated with SVT or paroxysmal atrial fibrillation
      • pre-excited QRS (delta waves) on ECG
      • suspected malfunction of pacemaker or ICD
      • absence of prodrome
      • associated injury
      • occurs while supine or sitting
      • Seizures
  • Category 2
    (appointment within 90 calendar days)
    • Recurrent syncope previously investigated with undetermined cause
  • Category 3
    (appointment within 365 calendar days)
    • No Category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Description of syncopal/pre-syncopal events including the following:
    • timeline
    • precipitating factors
    • any warning pre-syncopal symptoms
    • complete LOC or partial
    • duration of LOC
    • nature of recovery
    • witnessed signs
    • seizures
    • pallor
    • incontinence
    • cyanosis
    • irregular or absent pulse during attack
    • associated injury
  • Lying / standing or sitting / standing BP
  • Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
  • FBC, TSH, ELFTs, magnesium results
  • All available ECGs

3. Additional referral information Useful for processing the referral

  • Details of all treatments offered and efficacy
  • Relevant medical history
  • Family history of cardiac disease or sudden cardiac death
  • Holter monitor report (only useful if daily symptoms)
  • Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
  • FBC, TSH, ELFTs, magnesium results
  • Echocardiogram report (if available)
  • CXR report
  • History of drug use (including recreational drugs)

4. Request

Last updated: 22 June 2023