AHA/ACCF Scientific Statement on the Evaluation of Syncope

Strickberger, S. Adam; Benson, D. Woodrow; Biaggioni, Italo; Callans, David J.; Cohen, Mitchell I.; Ellenbogen, Kenneth A.; Epstein, Andrew E.; Friedman, Paul A.; Goldberger, Jeffrey J.; Heidenreich, Paul A.; Klein, George J.; Knight, Bradley P.; Morillo, Carlos A.; Myerburg, Robert J.; Sila, Cathy A.

doi:10.1161/circulationaha.105.170274

Cited by 259 publications

(64 citation statements)

References 74 publications

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“…Experienced clinicians rapidly identify precise details of the history that shift their thinking toward more serious diagnoses 5, 32, 33. Given the low incidence of serious disease, this experience has a limited role in refining that algorithm.…”

Section: Discussionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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BackgroundPediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).Methods and ResultsAmbulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.Conclusions SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.

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Section: Discussionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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“…42,43 It frequently occurs in older patients, and causes 6%-33% of syncope. 44,45 Diabetes and pharmacotherapy (Table 3) 1,13 may cause autonomic dysfunction manifesting with OH. 46 OH may be an early manifestation of Parkinson's disease and predicts mortality in middle-aged adults.…”

Section: Orthostatic Hypotension (Oh)mentioning

confidence: 99%

“…44 Transient episodes of near-syncope may also be clues in patients with ischemic cardiomyopathy. These patients should be referred to a cardiologist or electrophysiologist.…”

Section: Heart Disease and Syncopementioning

confidence: 99%

“…66 HUT and EP testing have limited diagnostic utility in this patient population. 44,67,68 An ICD is indicated in NIDCM with unexplained syncope and in patients with EF Ͻ 35%. [68][69][70] These patients should be referred to an electrophysiologist for further evaluation due to the risk of arrhythmia related sudden cardiac death.…”

Section: Nonischemic Dilated Cardiomyopathy (Nidcm)mentioning

confidence: 99%

“…HCM prevalence is 0.2%. 44 The 1% annual risk of sudden death results from VT or VF. 71,72 Patients with HCM with high risk markers should be referred to an electrophysiologist for consideration of ICD.…”

Section: Left Ventricular Outfl Ow Syndromesmentioning

confidence: 99%

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Evaluation and Management of Syncope

Bindra

Marchlinski

Lin

2008

Clinical medicine. Circulatory, respiratory and pulmonary medic

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Context Syncope is a commonly encountered by primary care physicians and cardiologists. Etiology is frequently not apparent, and patients may undergo unnecessary tests. Treatment must be tailored to the likely etiology. Complexities of diagnosis and treatment often warrant referral to a specialist. Objective To highlight the evolving recommendations for managing syncope in a clinically and cost effective manner. Evidence Acquisition An electronic literature search was undertaken of the Medline database from January 1996 to April 2006, using the Medical Subject Heading syncope, defibrillators, pacemakers, echocardiogram, cardiomyopathy, long QT syndrome, Arrhythmogenic right ventricular dysplasia, and Brugada syndrome. Abstracts and titles were reviewed to identify English-language trials. Bibliographies from the references as well as scientific statements from the Heart Rhythm Society, American Heart Association, and American College of Cardiology were reviewed. Evidence Synthesis A methodical approach to syncope can improve diagnosis, limit testing, and identify patients at risk of fatal outcome. A thorough history, physical exam and electrocardiogram are critical to the initial diagnosis. Presence of heart disease determines the extent of work-up and treatment. A trans-thoracic echocardiogram should be performed in patients with an unclear diagnosis and a positive cardiac history or an abnormal ECG. Ventricular arrhythmias are the most common cause of syncope in patients with structural heart disease. Patients with an ejection fraction less than 30 percent should receive an implantable defibrillator with few exceptions. An electrophysiology study may assist risk stratification in syncopal patients with borderline ventricular function. In patients without structural heart disease, the presence of a well defined arrhythmia syndrome consistent with a genetically determined risk of sudden death must be sought. The 12-lead electrocardiogram, family history and clinical presentation will identify most high-risk patients. Patients without structural heart disease can often be managed conservatively with well defined strategies for preventing neurocardiogenic syncope. Conclusions Managing syncope requires a methodical approach. An understanding of the limitations of the diagnostic tools and treatments is important. Lethal causes of syncope make it imperative to recognize the appropriate timing of referring patients to specialists.

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Assessing the Value of a Diagnostic Test

Heidenreich¹

2009

Arch Intern Med

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AHA/ACCF Scientific Statement on the Evaluation of Syncope

Cited by 259 publications

References 74 publications

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Evaluation and Management of Syncope

Assessing the Value of a Diagnostic Test

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