Syncope (fainting)
What the FAA's documents say about syncope (fainting), in plain words, with the FAA's own words one press away.
FAA term: Syncope
Show the FAA's words: which classes the FAA's table covers
SYNCOPE All Classes
Short version
The disposition table has three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AA simple, known cause, and completely resolved | Examiner issues | Examiner can issue |
| Row BAn unknown or unexplained cause, or multiple unrelated events | Defers to the FAA | Special Issuance |
| Row CUnexplained after a cardiac evaluation found no cardiac cause | Defers to the FAA | FAA review |
Show the FAA's words: the FAA's table for Syncope (fainting)
- Row A · Examiner can issue
A simple, known cause (for example, a blood draw), and completely resolved. The table notes it may be single or multiple events from a known cause. If an underlying cause "if found" (as printed), or the syncope is from head injury or associated with drugs or alcohol, the table says to see that section. The examiner should gather information regarding the diagnosis, severity, treatment and symptoms, and address all of the questions on the Syncope Decision Tool for the AME. If all of its items are in the NO/clear column, the examiner may issue, and summarizes this history and annotates Block 60. If there are any YES answers, any examiner concerns, or the history cannot be verified, the table says go to row B.
A. Simple, known cause* (e.g., blood draw) AND Completely resolved *May be single or multiple events from known cause. The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Syncope Decision Tool for the AME. If an underlying cause if found, or if from head injury or associated with drugs or alcohol, see that section. If ALL items on the Syncope Decision Tool are in the “NO”/clear column, the AME may: ISSUE Summarize this history and annotate Block 60 with “Discussed the history of SYNCOPE, no positives to screening questions, and no concerns.” If any “YES” answers, any AME concerns, or unable to verify history - go to Row B.
- Row B · Special Issuance
An unknown or unexplained cause, or multiple unrelated syncopal events. If due to a cardiac cause such as myocardial infarction or ischemia, the table says to see that page. The table lists what to submit for FAA review, and says testing must be performed within the past 90 days to be considered current. The examiner defers and submits the information to the FAA for a possible Special Issuance.
B. Unknown or unexplained cause OR Multiple unrelated syncopal events If due to a cardiac cause such as myocardial infarction or ischemia, see that page Submit the following for FAA review: Testing must be performed within the past 90 days to be considered current. … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row C · FAA review
Unexplained syncope after a cardiac evaluation has been performed, and no cardiac cause found. The table asks for the items in row B and a current, detailed neurological evaluation. Its note says that if there is no definitive cause for syncope (for example, unexplained loss of consciousness), a two (2) year recovery period is required, and if head injury occurred, to see that page. The examiner defers and submits the information to the FAA.
C. Unexplained syncope AFTER a cardiac evaluation has been performed (and no cardiac cause found) Submit the following for FAA review: • Items in Row B … Note: If no definitive cause for syncope (e.g., unexplained loss of consciousness), a two (2) year recovery period is required. If head injury occurred, see that page. DEFER Submit the information to the FAA.
The FAA pathways for syncope (fainting)
- How this pathway works: Examiner can issueNo special pathwayRow A
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateRow B
- FAA reviewYour AME defers. The FAA decides.Row C
Which one describes yours?
The FAA's table sorts it these ways. Choose yours to see its plan.
Your step-by-step plan
Step 1: What the examiner reviews
For a simple, known cause, completely resolved.Your AME addresses all the questions on the Syncope Decision Tool for the AME, in the in-office exam and history review.
The tool's six questions, each NO or YES
- Any question or uncertainty as to what likely caused the event
- Whether you were incapacitated after the event, and for how long
- Any additional, unrelated syncopal events within the past five (5) years
- Anything in the history that makes your AME question whether the event is of aeromedical concern
- If a medical professional evaluated it: cardiac syncope, or any evidence of cardiac pathology or cause
- Any concerns of your AME's, or a history that cannot be completed
What follows
- All NO: your AME may issue, and notes the history in Item 60
- Any single YES, or your AME unsure of the criteria, the diagnosis or severity: your AME defers
The tool is for your AME's use and does not have to be submitted to the FAA.
Show the FAA's words: What the examiner reviews
The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Syncope Decision Tool for the AME.
If ALL items on the Syncope Decision Tool are in the “NO”/clear column, the AME may: ISSUE
If any “YES” answers, any AME concerns, or unable to verify history - go to Row B.
FAA source: Syncope Disposition Table. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
The AME should elicit what likely caused the syncopal episode(s). If the individual has recently been exposed to these event(s) (e.g., blood draw, dehydration, etc.), do they continue to react? The AME should also take into consideration the likelihood of the likely cause being encountered when flying or in everyday life.
AME Instructions: Address each the following items in your in-office exam and history review:
1. Was there any question or uncertainty as to what likely caused the event? (Common causes of syncope include viral illness, GI, prolonged standing, dehydration, or blood draw.)
2. Was the individual incapacitated after the event? If yes, how long?
3. Have there been any additional, unrelated syncopal event(s) within the past five (5) years?
4. Are there any elements in the history (such as nature of the triggers or resultant injury) which cause you to question whether the event is of aeromedical concern?
5. If evaluated by a medical professional: Was the diagnosis cardiac syncope or any evidence of cardiac pathology/cause?
6. Do you have ANY concerns regarding this individual or are unable to obtain a complete history?
FAA source: Syncope Decision Tool for the AME. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
If the AME is unsure of any of the above criteria, the diagnosis, or severity - DEFER and describe in Item 60
*If ALL items fall into the clear/NO column, the AME may issue with notes in Item 60 which show you discussed the history of syncope, found no positives to the screening questions, AND had no concerns.
If ANY SINGLE ITEM falls into the SHADED/YES COLUMN, the AME MUST DEFER. The AME report should note what aspect caused the deferral and explain any YES answers from the shaded column.
This decision tool is for AME use; it does not have to be submitted to the FAA.
FAA source: Syncope Decision Tool for the AME. FAA date 25 March 2026; checked by Crosscheck 14 October 2026.
ISSUE Summarize this history and annotate Block 60 with “Discussed the history of SYNCOPE, no positives to screening questions, and no concerns.”
FAA source: Syncope Disposition Table. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
Step 2: See your AME
The examiner should gather information regarding the diagnosis, severity, treatment and symptoms, and address all of the questions on the Syncope Decision Tool for the AME. If all of its items are in the NO/clear column, the examiner may issue, and summarizes this history and annotates Block 60. If there are any YES answers, any examiner concerns, or the history cannot be verified, the table says go to row B.Exam day- The examiner should gather information regarding the diagnosis, severity, treatment and symptoms, and address all of the questions on the Syncope Decision Tool for the AME. If all of its items are in the NO/clear column, the examiner may issue, and summarizes this history and annotates Block 60. If there are any YES answers, any examiner concerns, or the history cannot be verified, the table says go to row B.
Show the FAA's words: See your AME
A. Simple, known cause* (e.g., blood draw) AND Completely resolved *May be single or multiple events from known cause. The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Syncope Decision Tool for the AME. If an underlying cause if found, or if from head injury or associated with drugs or alcohol, see that section. If ALL items on the Syncope Decision Tool are in the “NO”/clear column, the AME may: ISSUE Summarize this history and annotate Block 60 with “Discussed the history of SYNCOPE, no positives to screening questions, and no concerns.” If any “YES” answers, any AME concerns, or unable to verify history - go to Row B.
FAA source: Syncope Disposition Table. FAA date 29 May 2024; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The examiner should gather information regarding the diagnosis, severity, treatment and symptoms, and address all of the questions on the Syncope Decision Tool for the AME. If all of its items are in the NO/clear column, the examiner may issue, and summarizes this history and annotates Block 60. If there are any YES answers, any examiner concerns, or the history cannot be verified, the table says go to row B.
Row BDefers to the FAASpecial Issuance
The table lists what to submit for FAA review, and says testing must be performed within the past 90 days to be considered current. The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defersRow CDefers to the FAAFAA review
The table asks for the items in row B and a current, detailed neurological evaluation. Its note says that if there is no definitive cause for syncope (for example, unexplained loss of consciousness), a two (2) year recovery period is required, and if head injury occurred, to see that page. The examiner defers and submits the information to the FAA.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
A simple, known cause (for example, a blood draw), and completely resolved. The table notes it may be single or multiple events from a known cause. If an underlying cause "if found" (as printed), or the syncope is from head injury or associated with drugs or alcohol, the table says to see that section. The examiner should gather information regarding the diagnosis, severity, treatment and symptoms, and address all of the questions on the Syncope Decision Tool for the AME. If all of its items are in the NO/clear column, the examiner may issue, and summarizes this history and annotates Block 60. If there are any YES answers, any examiner concerns, or the history cannot be verified, the table says go to row B.
A. Simple, known cause* (e.g., blood draw) AND Completely resolved *May be single or multiple events from known cause. The AME should gather information regarding the diagnosis, severity, treatment, symptoms, and address ALL of the questions on the Syncope Decision Tool for the AME. If an underlying cause if found, or if from head injury or associated with drugs or alcohol, see that section. If ALL items on the Syncope Decision Tool are in the “NO”/clear column, the AME may: ISSUE Summarize this history and annotate Block 60 with “Discussed the history of SYNCOPE, no positives to screening questions, and no concerns.” If any “YES” answers, any AME concerns, or unable to verify history - go to Row B.
- Row B · Special Issuance
An unknown or unexplained cause, or multiple unrelated syncopal events. If due to a cardiac cause such as myocardial infarction or ischemia, the table says to see that page. The table lists what to submit for FAA review, and says testing must be performed within the past 90 days to be considered current. The examiner defers and submits the information to the FAA for a possible Special Issuance.
B. Unknown or unexplained cause OR Multiple unrelated syncopal events If due to a cardiac cause such as myocardial infarction or ischemia, see that page Submit the following for FAA review: Testing must be performed within the past 90 days to be considered current. … DEFER Submit the information to the FAA for a possible Special Issuance.
- Row C · FAA review
Unexplained syncope after a cardiac evaluation has been performed, and no cardiac cause found. The table asks for the items in row B and a current, detailed neurological evaluation. Its note says that if there is no definitive cause for syncope (for example, unexplained loss of consciousness), a two (2) year recovery period is required, and if head injury occurred, to see that page. The examiner defers and submits the information to the FAA.
C. Unexplained syncope AFTER a cardiac evaluation has been performed (and no cardiac cause found) Submit the following for FAA review: • Items in Row B … Note: If no definitive cause for syncope (e.g., unexplained loss of consciousness), a two (2) year recovery period is required. If head injury occurred, see that page. DEFER Submit the information to the FAA.
If the examiner defersSpecial Issuance
The table marks row B, an unknown or unexplained cause or multiple unrelated syncopal events, DEFER.
The table marks row C, unexplained syncope after a cardiac evaluation found no cardiac cause, DEFER.
In row A, the table sends any YES answers, any examiner concerns, or a history the examiner is unable to verify to row B.
The Syncope Decision Tool says the examiner must defer if any single item falls into the shaded/YES column, and to defer and describe in Item 60 if the examiner is unsure of any of its criteria, the diagnosis, or severity.
What the FAA lists to send
- Item 1. A cardiac evaluation.
- Item 2. An echocardiogram (echo).
- Item 3. An exercise stress test (EST).
- Item 4. A 14-day Holter (event) monitor.
- Item 5. Labs -- hemoglobin A1c, a lipid panel and a complete blood count.
- Item 6. The EMS/ambulance run sheet, if applicable.
- Item 7. Emergency Department records, if applicable.
- Item 8. If age 40 or older at the time of the event, a carotid duplex ultrasound performed within the previous one (1) year.
- Item 9. For row C, also a current, detailed neurological evaluation that meets the FAA Specifications for Neurologic Evaluation, from a clinic visit with the treating neurologist no more than 90 days before the exam.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table marks row B, an unknown or unexplained cause or multiple unrelated syncopal events, DEFER.
B. Unknown or unexplained cause OR Multiple unrelated syncopal events … DEFER Submit the information to the FAA for a possible Special Issuance.
- Reason 2
The table marks row C, unexplained syncope after a cardiac evaluation found no cardiac cause, DEFER.
C. Unexplained syncope AFTER a cardiac evaluation has been performed (and no cardiac cause found) … DEFER Submit the information to the FAA.
- Reason 3
In row A, the table sends any YES answers, any examiner concerns, or a history the examiner is unable to verify to row B.
If any “YES” answers, any AME concerns, or unable to verify history - go to Row B.
- Reason 4
The Syncope Decision Tool says the examiner must defer if any single item falls into the shaded/YES column, and to defer and describe in Item 60 if the examiner is unsure of any of its criteria, the diagnosis, or severity.
If the AME is unsure of any of the above criteria, the diagnosis, or severity - DEFER and describe in Item 60 … If ANY SINGLE ITEM falls into the SHADED/YES COLUMN, the AME MUST DEFER.
What the FAA lists to send
- Item 1
A cardiac evaluation.
Testing must be performed within the past 90 days to be considered current. • Cardiac Evaluation;
- Item 2
An echocardiogram (echo).
• Echocardiogram (Echo);
- Item 3
An exercise stress test (EST).
• Exercise Stress Test (EST);
- Item 4
A 14-day Holter (event) monitor.
• 14-day Holter (event) monitor;
- Item 5
Labs -- hemoglobin A1c, a lipid panel and a complete blood count.
• Lab: o Hemoglobin A1c o Lipid panel o Complete Blood Count
- Item 6
The EMS/ambulance run sheet, if applicable.
• EMS/ambulance run sheet (if applicable);
- Item 7
Emergency Department records, if applicable.
• Emergency Department records (if applicable); and
- Item 8
If age 40 or older at the time of the event, a carotid duplex ultrasound performed within the previous one (1) year.
• If age 40 or older at time of event, a carotid duplex ultrasound performed within the previous one (1) year.
- Item 9
For row C, also a current, detailed neurological evaluation that meets the FAA Specifications for Neurologic Evaluation, from a clinic visit with the treating neurologist no more than 90 days before the exam.
• Items in Row B • A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workGood to know
Points from the FAA's own documents that are easy to miss.
One YES answer moves the case to row B
In row A, the table says any YES answers on the Syncope Decision Tool, any examiner concerns, or a history the examiner is unable to verify go to row B, which is marked DEFER.
Show the FAA's words: good to know, 1
If any “YES” answers, any AME concerns, or unable to verify history - go to Row B. … DEFER Submit the information to the FAA for a possible Special Issuance.
Testing within the past 90 days
For row B, the table says testing must be performed within the past 90 days to be considered current. The carotid duplex ultrasound has its own line, within the previous one (1) year.
Show the FAA's words: good to know, 2
Testing must be performed within the past 90 days to be considered current. … • If age 40 or older at time of event, a carotid duplex ultrasound performed within the previous one (1) year.
The carotid ultrasound follows age at the time of the event
The table asks for a carotid duplex ultrasound if the pilot was age 40 or older at the time of the event.
Show the FAA's words: good to know, 3
• If age 40 or older at time of event, a carotid duplex ultrasound performed within the previous one (1) year.
No definitive cause means a two-year recovery period
The table's note in row C says that if there is no definitive cause for syncope (for example, unexplained loss of consciousness), a two (2) year recovery period is required.
Show the FAA's words: good to know, 4
Note: If no definitive cause for syncope (e.g., unexplained loss of consciousness), a two (2) year recovery period is required.
Some causes have their own page
The table says that if an underlying cause "if found" (as printed), or the syncope is from head injury or associated with drugs or alcohol, to see that section; if due to a cardiac cause such as myocardial infarction or ischemia, to see that page; and in row C, if head injury occurred, to see that page.
Show the FAA's words: good to know, 5
If an underlying cause if found, or if from head injury or associated with drugs or alcohol, see that section. … If due to a cardiac cause such as myocardial infarction or ischemia, see that page … If head injury occurred, see that page.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.