UNEXPLAINED SYNCOPE CARDIAC DIAGNOSTICS & MONITORING
Find the answers for your unexplained syncope patients
THE SYNCOPE CHALLENGE
Syncope is Common. Finding the Cause Matters.
SYNCOPE WITH A CARDIAC CAUSE INCREASES MORTALITY RATES
Cardiac syncope can be a predictor of sudden cardiac death3
PATIENTS WANT ANSWERS
Syncope patients endure ongoing diagnostic testing and still come away with no answers5
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:
|
SYNCOPE EVALUATION CARE PATHWAY
Cardiac Monitoring Selection Criteria
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.