Syncope Patient

UNEXPLAINED SYNCOPE CARDIAC DIAGNOSTICS & MONITORING

Find the answers for your unexplained syncope patients

THE SYNCOPE CHALLENGE

Syncope is Common. Finding the Cause Matters.

Syncope Clinical Impact Chart

SYNCOPE WITH A CARDIAC CAUSE INCREASES MORTALITY RATES

Cardiac syncope can be a predictor of sudden cardiac death3

Syncope Mortality Chart

PATIENTS WANT ANSWERS

Syncope patients endure ongoing diagnostic testing and still come away with no answers5

Syncope Tests Chart


2017 AHA/ACC/HRS Guidelines for the Management of Syncope6

Initial Evaluation of Patients with Syncope

Recommendations for History, Physical Examination, and Risk Assessment

Class Level of Evidence Recommendations

I

B-NR

A detailed history and physical examination should be performed in patients with syncope

I

B-NR

Evaluation of the cause and assessment for the short- and long-term morbidity and mortality risk of syncope are recommended

Historical Characteristics Associated with Increased Probability of Cardiac Causes of Syncope

  • Presence of ischemic heart disease, structural heart disease, previous arrhythmias, or reduced ventricular function
  • Brief (palpitations) or no symptoms prior to loss of consciousness
  • Occurs with exertion
  • Occurs in supine position
  • Low number of events (1 or 2)
  • Abnormal cardiac examination
  • Family history of inheritable conditions or premature SCD (<50 yr of age)
  • Presence of known congenital heart disease

Additional Evaluation and Diagnosis

Recommendations for Cardiac Monitoring

The choice of monitoring system and duration should be appropriate to the likelihood that a spontaneous event will be detected, and the patient may be incapacitated and unable to voluntarily trigger the recording system.

Class Level of Evidence Recommendation

I

C-EO

The choice of a specific cardiac monitor should be determined on the basis of the frequency and nature of syncope events.

IIa

B-R

To evaluate selected ambulatory patients with syncope of suspected arrhythmic etiology, an ICM can be useful.

IIa

B-NR

To evaluate selected ambulatory patients with syncope of suspected arrhythmic etiology, the following external cardiac monitoring approaches can be useful:

  1. Holter monitor
  2. Transtelephonic monitor
  3. External loop recorder
  4. Patch recorder
  5. Mobile cardiac outpatient telemetry

SYNCOPE EVALUATION CARE PATHWAY

Syncope Guidelines Chart


Cardiac Monitoring Selection Criteria

Syncope Monitor Choice Chart

SELECT THE RIGHT MONITOR FOR THE RIGHT PATIENT. CONTINUE MONITORING. GET TO THE ANSWER.


1

Sun BC, Emond JA, Camargo CA Jr. Inconsistent electrocardiographic testing for syncope in United States emergency departments. Am J Cardiol. May 15, 2004;93(10):1306-1308.

2

Mendu ML, McAvay G, Lampert R, Stoehr J, Tinetti ME. Yield of diagnostic tests in evaluating syncopal episodes in older patients. Arch Intern Med. July 27, 2009;169(14):1299-1305.

3

Engel GL. Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med. September 1978;89(3):403-412.

4

Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med. September 19, 2002;347(12):878-885.

5

Edvardsson N, Frykman V, van Mechelin R, et al. Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry. Europace. February 2011;13(2):262-269.

6

Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. J Am Coll Cardiol. Published online March 9, 2017.