1st Guideline on Evaluation and Management of Syncope

The American College of Cardiology, with the American Heart Association and the Heart Rhythm Society, has released a guideline on the evaluation and management of patients with syncope. The document is published in Journal of the American College of Cardiology, Circulation and HeartRhythm. Until now, there have been no written standards outlining the best course of action to take when treating patients who faint.

Syncope, or fainting, is caused by an insufficient supply of blood, and therefore oxygen, to the brain. According to the guideline, the most common cause of fainting usually occurs while standing when blood pressure drops, reducing circulation to the brain and causing loss of consciousness. This condition is not life threatening although it can cause worries and interfere with one's quality of life. The guideline recommends that physicians should inform patients that common faints are not life threatening.

Other recommendations in the ACC/AHA/HRS guideline include:

• If a patient faints, a doctor should perform a detailed history and physical examination during the initial evaluation.
• Using an electrocardiogram (ECG) when initially evaluating patients who faint is useful. It is important to find out the cause of fainting and treat the heart condition in the patient if he or she has an abnormal ECG after fainting.
• If a person has a serious medical condition that could be related to their fainting, they should be evaluated and/or treated at a hospital after the initial assessment.
• Some tests are not useful in evaluating patients who faint, including: routine laboratory testing, routine cardiac imaging, like an MRI or CT scan, unless the patient has a suspected cardiac issue, and carotid artery or head imaging, unless there is a specific reason why the patient needs to be evaluated further.
• Beta-blockers can be a good choice in patients who faint and who have certain heart conditions as defined in the guidelines.
• Patients who faint and who also have certain types of heart issues as defined in the guidelines should restrict their exercise.
• An athlete who has problems with fainting should have a heart assessment done by an experienced healthcare provider or specialist before returning to competitive sports.

"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, chair of the writing group that developed the guidelines. "That means there is a very good chance these guidelines will either affect you directly or someone you know. Therefore, having these guidelines is not only good for the clinicians using them – but for everyone."

Source: American College of Cardiology
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