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

Shen, Win‐Kuang; Sheldon, Robert S.; Benditt, David G.; Cohen, Mitchell I.; Forman, Daniel E.; Goldberger, Zachary D.; Grubb, Blair P.; Hamdan, Mohamed H.; Krahn, Andrew D.; Link, Mark S.; Olshansky, Brian; Raj, Satish R.; Sandhu, Roopinder K.; Sorajja, Dan; Sun, Benjamin; Yancy, Clyde W.

doi:10.1161/cir.0000000000000499

Cited by 316 publications

(628 citation statements)

References 734 publications

(397 reference statements)

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“…266 Recent studies suggest electrocardiographic findings predictive of serious cardiac outcomes, which include Mobitz 2 or complete atrioventricular block, severe conduction sys tem disease, new ischemic changes, nonsinus rhythm, left axis deviation, or other abnormalities noted from electrocardiographic monitoring in the ED. 269 The ACC/AHA/Heart Rhythm Society 2017 guideline for the evaluation and management of patients with syn cope 270 provides recommendations for hospital admission for syncope. This guideline also states that patients with a suspected cardiac cause of their syncope are vulnerable to arrhythmias and thus should undergo electrocardio graphic monitoring.…”

Section: Syncope Of Suspected Cardiac Originmentioning

confidence: 99%

“…Algorithms using a detailed medical history, family his tory, physical examination, and 12lead ECG have been developed to help distinguish between benign syncope and malignant cardiac conditions requiring further eval uation. 270,276,277 If a patient is believed to have a cardiac condition that requires admission, consideration should be given to arrhythmia monitoring.…”

Section: Syncope Of Suspected Cardiac Originmentioning

confidence: 99%

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Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

206

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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Section: Syncope Of Suspected Cardiac Originmentioning

confidence: 99%

Section: Syncope Of Suspected Cardiac Originmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

206

214

View full text Add to dashboard Cite

show abstract

“…OI presents with symptoms such as lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision, exercise intolerance, and fatigue upon standing. The typical signs and symptoms are often related to reduced perfusion of the brain during orthostatic stress for common forms of OI, 20 orthostatic hypotension, neurally mediated syncope, and postural orthostatic tachycardia syndrome. Autonomic function testing is an important diagnostic tool for assessing the autonomic nervous system in patients with symptoms of OI.…”

Section: Application Of Nirs In Autonomic Nervous System Disordersmentioning

confidence: 99%

Application of near-infrared spectroscopy in clinical neurology

Kim

Bae

2018

Ann Clin Neurophysiol

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Near-infrared spectroscopy (NIRS) monitoring has been used mainly to detect reduced perfusion of the brain during orthostatic stress in order to assess orthostatic intolerance (OI). Many studies have investigated the use of NIRS to reveal the pathophysiology of patients with OI. Research using NIRS in other neurological diseases (e.g., stroke, epilepsy, and migraine) is continuing. NIRS may play an important role in monitoring the regional distribution of the hemodynamic flow in real time and thereby reveal the underlying pathophysiology and facilitate the management of not only patients with OI symptoms but also those with various neurological diseases.Key words: Orthostatic intolerance; Near-infrared spectroscopy; Clinical neurology INTRODUCTIONMany studies have investigated the hemodynamics and functions of the brain in various fields.1 Several noninvasive methods have been introduced in recent decades for measuring neuronal activity in the brain. 2 Neurophysiological techniques such as electroencephalography, magnetoencephalography, and event-related potentials offer the ability to measure overall changes in the electromagnetic field with an excellent time resolution, but these methods have poor spatial resolution. On the other hand, brain imaging techniques such as positron-emission tomography (PET) and functional magnetic resonance imaging (fMRI) have greatly increased our knowledge about neural circuitry. However, PET is highly sensitive to motion artifacts, confines the patient, and involves the injection of radioactive materials. Although fMRI is noninvasive and has excellent spatial resolution, it is expensive, highly sensitive to motion artifacts, and difficult to integrate with other imaging modalities. 3,4 Near-infrared spectroscopy (NIRS) was introduced as a new neuroimaging modality for Principle of NIRSNIRS is a noninvasive optical imaging tool for observing changes in the hemodynamics in the prefrontal area that is based on measuring the concentrations of HbO and HbR in the blood. Since Franz Jöbsis first studied the oxygenation of living tissues, NIRS has been extensively applied in imaging studies of brain activation. 6 The physiological activation of neurons leads to an imbalance between oxygen supply and utilization, increasing the concentration of HbO and decreasing the concentration of HbR. Most tissues are relatively transparent to light in the near-infrared range from 700 to 900 nm, and photons interact with tissues via absorption and scattering. This means that near-infrared light is less absorbed and scattered by tissue than is light at other wavelengths. 7 This range of wavelengths is often called an optical window since the light can easily pass through most tissues; however, it is reflected by HbO and HbR, and hence the absorption and scattering of light used for NIRS can provide information relevant to neural activity. 8 This light penetrates several centimeters through tissue and can still be detected (Fig. 1). The NIRS system consists of a light source and a photodetector. The l...

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“…ECG remains essential in the initial evaluation for identifying potential and specific causes of syncope (16). Emergency physicians must maintain a high index of suspicion to identify inherited conditions when patients present to the ED.…”

Section: Resultsmentioning

confidence: 99%

Syncope in a Young Man

Chng¹,

Goh²

2018

J Emerg Med Case Rep

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A 31-year-old Bangladeshi man with no medical history of note was brought into the ED by his friends. He had an episode of syncope while driving. His vital signs on arrival were blood pressure, 116/70 mmHg; respiratory rate, 16/min; oxygen saturation, 100% on room air, and temperature, 36°C. The patient was slightly drowsy but arousable. Physical examination was unremarkable. His blood glucose level was 8.9 mmol/L. ECG was performed on arrival (Figure 1). Shortly after arrival, the patient developed two episodes of tonic-clonic seizures that stopped spontaneously. He was immediately intubated for airway protection. Repeat ECG showed atrial fibrillation with ST depression in anterolateral leads (Figure 2).A few minutes post-intubation, he developed two episodes of ventricular fibrillation (VF), both of which responded to biphasic defibrillation of 150 J. Slow intravenous bolus of 150 mg amiodarone (cordarone; Wyeth Pharmaceuticals Inc.

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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

Cited by 316 publications

References 734 publications

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Application of near-infrared spectroscopy in clinical neurology

Syncope in a Young Man

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