Treatment-syncope

(JACC 2017;70:620 & 2019;74:2410; EHJ 2018;39:1883)

• Arrhythmia, cardiac mechanical or neurologic syncope: treat underlying disorder, ? ICD if Brugada pattern, sarcoid, ARVC, early repol + syncope
• Vasovagal: avoidance of triggers; physical counterpressure; consider ↑ Na & fluid intake, fludrocortisone or midodrine (JACC 2016;68:1; Ann Intern Med 2021;174:1349); SSRI; ? βB; consider PPM if recurrent + pauses on recorder or tilt test (EHJ 2021;42:508)
• Orthostatic: 2–3 L fluid & 10 g Na per day; rise from supine to standing slowly, compression stockings; consider: midodrine, fludrocortisone, droxidopa, ? pyridostigmine, ? octreotide