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Thursday, September 17, 2009

Guidelines for the Diagnosis and Management of Syncope - European Society of Cardiology

The European Society of Cardiology has just published new guidelines for the diagnosis and management of syncope (Eur Heart J 2009;Aug 27:[Epub ahead of print].)

Cardiosource's Fred Morady just wrote an excellent synopsis of 10 points to remember from the new guidelines.

I like it so much, I am reproducing below. If you want to read it from its original site.

Perspective: The following are 10 points to remember from these syncope guidelines, developed by the European Society of Cardiology:

1. The two most common causes of syncope are neurocardiogenic syncope and cardiac disorders, which together account for >50% of syncopal episodes.

2. The initial evaluation of patients >40 years should include sequential right and left carotid sinus massage for 10 seconds; asystole >3 seconds with reproduction of symptoms is indicative of carotid sinus syndrome.

3. The main indication for tilt testing is to confirm neurocardiogenic syncope when this diagnosis is suspected. Tilt testing is of no value for assessing the response to therapy.

4. Implantable loop recorders may be more cost-efficient than conventional monitoring or external loop recorders for providing a diagnosis in patients with sporadic syncope.

5. Electrophysiological testing is unnecessary in patients with syncope and an ejection fraction <30-35%, because such patients are appropriate candidates for an implantable cardioverter-defibrillator regardless of the results of the electrophysiological test.

6. Electrophysiological testing may be useful in patients with syncope and suspected intermittent bradycardia, atrioventricular block, or paroxysmal tachycardia.

7. First-line therapy of neurocardiogenic syncope consists of patient education on hydration, high salt intake, avoidance of triggers, recognition of prodromal symptoms, supine posture, isometric contraction of large muscle groups, and avoidance of alcohol.

8. The majority of randomized, placebo-controlled trials have shown that beta-blockers, disopyramide, scopolamine, midodrine, clonidine, and serotonin reuptake inhibitors do not prevent neurocardiogenic syncope.

9. When evaluated in double-blinded fashion, pacing did not significantly reduce the recurrence rate of neurocardiogenic syncope.

10. Unexplained syncope is a major risk factor for sudden death in hypertrophic cardiomyopathy if it occurred within 6 months before evaluation.

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