2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope

Is neuroimaging necessary to evaluate syncope?

“…Syncope is an abrupt loss of consciousness due to transient global cerebral hypoperfusion, with a concomitant loss of postural tone and rapid, spontaneous recovery. 1 Recovery from syncope is characterized by immediate restoration of orientation and normal behavior, although the period after recovery may be accompanied by fatigue. 2 The European Society of Cardiology 2 has classifi ed syncope into 3 main categories: refl ex (neurally mediated) syncope, syncope due to orthostatic hypotension, and cardiac syncope.…”

Use of the Clinical Examination in the Diagnosis of Cardiac Syncope

“…Studies often included a wide age range of patients despite the incidence of syncope, related ED visits, and serious outcomes increasing sharply after the age of 60. 7 Cardiac biomarkers such as troponin or BNP testing appear to be an attractive diagnostic option, however, they did not rule in or rule out cardiac syncope. Moreover, these cardiac biomarkers were likely used to diagnose cardiac syncope leading to incorporation bias.…”

Debatable issues in automated ECG reporting

“…[13] In addition, it is used to uncover the cause of palpitations, recurrent unexplained falls, arrhythmia evaluation in obstructive sleep apnea, and for post-cardiac surgery arrhythmia evaluation. In addition, there is emerging evidence for MCT advantage in both time to initiation of drug therapy and inpatient cardiovascular patient costs.…”

“…With an aging population, there is justifiable concern about unsustainable health care expenditures. Future research is required to determine whether a similar diagnostic yield and patient outcome could 13 be achieved with non-real time monitoring before this technology is adopted into routine care for patients at risk for arrhythmia.…”