[Syncope; suspect pulmonary embolism, especially in the elderly].

Syncope can be caused by a pulmonary embolism. This applies in particular to elderly patients admitted with syncope; in the general population, however, syncope is far more frequently caused by a vasovagal response or orthostatic hypotension. Syncope can be the symptom of a pulmonary embolism, even in the absence of any clinical manifestations of this diagnosis; it is, therefore, important to exclude pulmonary embolism in any syncope patient in the accident and emergency department by applying the Wells clinical decision rule. GPs should also be alert to syncope as a possible symptom of pulmonary embolism, and be alert to breathing rate and signs of venous thrombosis.