FOR APPs & PRIMARY CARE CLINICIANS
Syncope & rhythm monitoring — Quick reference
First steps, urgent findings, referral guidance, and handoff essentials.
First steps
Obtain a witness/event timeline, review triggers/prodrome/recovery, check orthostatics when safe, and obtain an EKG. Select testing by suspicion.
Recognize the urgent patient
Instability or concerning exertional/supine syncope, structural disease, or dangerous rhythm warrants prompt risk-based assessment.
When to refer
Refer recurrent unexplained or suspected cardiac syncope to cardiology/EP; choose monitoring duration by event frequency.
What to send with the referral
EKG; witness history; event frequency; orthostatics; medications; prior cardiac/monitor findings.
Avoid this pitfall
An uneventful monitor is nondiagnostic if the symptom did not occur. An ILR records rhythms but does not pace or shock.
Reviewed October 11, 2026. This quick reference summarizes the linked guide; use the full guide for context and clinical references.