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Personal Details
Patient/Carer additional information section (optional)

These details will help to inform, educate and raise awareness of syncope globally. Carers can complete on behalf of patients


  1. 24-hr EKG monitor
    Blood pressure
    Blood test
    Echocardiogram
    Exercise Test
    EP Study
    12-Lead EKG
    7-14 Day EKG monitor
    EEG
    Implantable Cardiac Monitor
    Implantable Cardiac Monitor
    Pulse Check
    Tilt Table Test

  2. No device or procedure
    Cardiac Resynchronisation Therapy-Implantable Cardiac Defibrillator (ICD)
    Cardiac Resynchronisation Therapy-Pacemaker
    Implantable Cardiac Defibrillator (ICD)
    Implantable Loop Recorder
    Pacemaker
    Subcutaneous Implantable Cardiac Defibrillator (S-ICD)

  3. No medications
    Beta blockers
    Ivabradine
    Not sure of medications
    Anti-Epileptic Drugs (AEDs)
    Fludrocortisone
    Midodrine
    Octreotide
    Other (please specify)