Last reviewed: November 2017
Last updated: November  2017

Important updates

2017 guideline on the evaluation and management of patients with syncope

  • The update of this topic includes recommendations on the assessment of patients with syncope from the 2017 guideline by the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society (ACC/AHA/HRS).

  • A detailed history helps to identify prognostic factors. Physical examination should include careful assessment of heart rate and rhythm, and other signs that may indicate structural heart disease. A resting 12-lead ECG is a useful initial investigation.

  • The guideline recommends assessing short-term (up to 30 days after syncope) and long-term (up to 12 months of follow-up) risk of morbidity and mortality in people presenting with syncope.

See Diagnosis: approach

Original source of update

Summary

Differentials

Common

  • Acute coronary syndrome
  • Ventricular arrhythmias
  • Atrioventricular block
  • Acute atrial fibrillation
  • Congestive heart failure
  • Volume depletion
  • Sinus node dysfunction
  • Aortic stenosis
  • Upper GI bleeding
  • Lower GI bleeding
  • Neurally mediated
  • Orthostatic hypotension
  • Migraine
  • Seizure

Uncommon

  • Wolff-Parkinson-White syndrome/preexcitation syndrome
  • Cardiac tamponade
  • Aortic dissection
  • Pulmonary embolism
  • Ruptured abdominal aortic aneurysm
  • Brugada syndrome
  • Long QT syndrome
  • Hypertrophic cardiomyopathy
  • Arrhythmogenic right ventricular cardiomyopathy
  • Mitral stenosis
  • Atrial myxoma
  • Cardiac sarcoidosis
  • Subclavian steal syndrome
  • Ectopic pregnancy
  • Hypoglycemia
  • Addison disease
  • Acute vertebrobasilar stroke
  • Psychogenic pseudosyncope

Contributors

Authors VIEW ALL

Sanjeev Wasson

Cardiac Electrophysiologist

Kearney Regional Medical Center

Kearney

NE

Disclosures

SW declares that he has no competing interests.

Dr Sanjeev Wasson would like to gratefully acknowledge Dr Sarabjeet Singh and Dr Nishant Kalra, the previous co-authors of this monograph. SS declares that he has no competing interests. NK declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Harvard Medical School

Director

The Clinical Decision Unit and Cardiac Emergency Center

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

SG declares that he has no competing interests.

Professor of Medicine

VA Greater Los Angeles Healthcare System

UCLA School of Medicine

Los Angeles

CA

Disclosures

DL declares that he has no competing interests.

Consultant Cardiologist

Heart and Lung Centre

New Cross Hospital

Wolverhampton

UK

Disclosures

SP has received funds for attending conferences, and fees for speaking and consultation, from Medtronic Inc. SP was also in receipt of funding for research, between 2007 and 2009, from Medtronic Inc. to the Uiversity of Manchester. SP was a Guideline Development Group member of the National Institute of Clinical Excellence guidelines on Transient loss of consciousness ('blackouts') management in adults and young people, published in August 2010.

Consultant Cardiologist

Department of Cardiology

King's College Hospital

London

UK

Disclosures

NG declares that he has no competing interests.

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