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Click on boxes to expand/collapse detailed information.               Characterize symptoms                                                                     Medication history                                                           Past medical history                                                           Possible triggers                                                           Physical examination                                                         Labs and tests                                                         Imaging studies                                                         Diagnostic features                                                                         Syncope           Non syncope loss of consciousness                                                                 Known etiology Cardiovascular Orthostatic hypotension Reflex         Unknown etiology Determine if there are any high risk criteria:       Consider additional tests                                                                         High risk       low risk       Consider alternative diagnoses                                                                                   ❑ Immediate in-hospital monitoring (in bed or telemetry) to look for abnormalities suggestive of arrhythmic syncope (Class I; Level of Evidence: B).   Recurrent syncopes   Single syncope                                                                                         If suspicion of structural hear disease: Order an echocardiography (Class I; Level of Evidence: B)   Was it in high risk setting? Potential risk of physical injury Occupational implications                                                                                                               Structural heart disease present Treat accordingly   No structural heart disease   Yes   No: No further evaluation                                                                                                 Tilt testing

Characterize the symptoms

Drug	Adult dosage
Inhaled Short Acting β Agonists (SABA)
Albuterol/Bitolterol/Pirbuterol a) Nebulizer solution b) MDI	♦ 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hour continuously. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed.
Levalbuterol a) Nebulizer solution b) MDI	♦ 1.25-2.5 mg every 20 mins for 3 doses, then 1.25-5 mg every 1-4 hours as needed. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed.
Anticholinergics
Ipratropium bromide a) Nebulizer solution b) MDI	♦ 0.5 mg every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for upto 3 hours.
Ipratropium with albuterol a) Nebulizer solution (each 3 ml containing 0.5 mg ipratropium and 2.5 mg albuterol) b) MDI (each puff contains 18 mcg ipratropium and 90 mcg albuterol)	♦ 3 ml every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for 3 hours
Systemic corticosteroids
Prednisone/Prednisolone/Methylprednisolone	♦ 40-80 mg/day in 1 or 2 divided doses until peak expiratory flowrate (PEF) reaches 70% of personal best.

Clinical course	Unstable
Physical examination	Signs of heart failure
Functional class	IV
6MWD	Less than 400 m
Echocardiogram	RV Enlargement
Hemodynamics	RAP high CI low
BNP	Elevated/Increasing
Treatment	Intravenous prostacyclin and/or combination treatment
Frequency of evaluation	Q 1 to Q 3 months
FC assessment	Every clinic visit
6MWT	Every clinic visit
Echocardiogram2	Q 6 to Q 12 months/center dependent
BNP	center dependent
RHC	Q 6 to Q 12 months or clinical deterioration