First-Ever Guideline Addresses Evaluation, Management of Syncope

The ACC, with the American Heart Association and the Heart Rhythm Society, released the first guideline for the evaluation and management of patients with syncope. The guideline, published March 9 in the Journal of the American College of Cardiology, aims to provide “contemporary, accessible, and succinct guidance on the management of adult and pediatric patients with suspected syncope.”

Specifically, the guideline includes recommendations on initial evaluation, as well as additional evaluation and diagnosis; management of cardiovascular conditions (i.e., structural, arrhythmic and inheritable conditions); uncommon conditions associated with syncope; and syncope in special populations. Additionally, the guideline addresses quality of life and health care costs of syncope and looks at emerging technologies, evidence gaps and future directions.

Of note, the guideline recommends that if a patient faints, a physician should perform a detailed history and physical examination during the initial evaluation. Using an electrocardiogram during this time may be useful to determine the cause of fainting. People with serious medical conditions that could be related to their fainting should be evaluated and/or treated at a hospital after the initial assessment.

Cardiology Magazine Image"Studies show that in the U.S., about one-third to half the population faints at some point in their lifetime. Therefore, having these guidelines is not only good for the clinicians using them – but for everyone." Win-Kuang Shen, MD, FACC

The guideline also explains that certain tests such as routine laboratory testing and routine cardiac imaging may not be useful in evaluating these patients unless the patient has a suspected cardiac issue. Carotid artery or head imaging may not be useful unless there is a specific reason why the patient needs to be evaluated further.

Depending on the reason for fainting, treatment options may include implantable cardioverter-defibrillators, beta-blockers or pacemakers. According to the guideline, patients who faint and who also have certain types of heart issues should restrict their exercise, and athletes who experience fainting should have a heart assessment done by an experienced health care provider or specialist before returning to competitive sports. Heart rhythm monitoring can be a good choice for patients with unexplained fainting who may have intermittent heart rhythm issues that cause fainting.

“Studies show that in the U.S., about one-third to half the population faints at some point in their lifetime,” said Win-Kuang Shen, MD, FACC, chair of the writing group. “Therefore, having these guidelines is not only good for the clinicians using them – but for everyone. Now that we have these guidelines, physicians and clinicians will be able to make better-informed decisions and this will contribute to improved patient outcomes.”

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Sports and Exercise and Imaging

Keywords: ACC Publications, Cardiology Magazine, American Heart Association, Cardiac Imaging Techniques, Carotid Arteries, Defibrillators, Implantable, Electrocardiography, Health Care Costs, Health Personnel, Quality of Life, Sports, Syncope

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