Sunday, 12 March 2017

New ACC/AHA/HRS guidelines for evaluation and management of syncope

New ACC/AHA/HRS guidelines for evaluation and management of syncope The American College of Cardiology, American Heart Association and the Heart Rhythm Society have jointly released a guideline for the evaluation and management of patients with syncope to be published simultaneously in the Journal of the American College of Cardiology, Circulation and Heart Rhythm. The new recommendations from the 2017 ACC/AHA/HRS guideline include: • If a patient faints, a doctor should perform a detailed history and physical examination during the initial evaluation. • 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. Physicians should inform patients that common faints are not life threatening. • 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. • There are a number of tests that are not useful in evaluating patients who faint. These include: 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. • Implantable cardioverter-defibrillators (ICD) can be helpful for certain patients who faint because they have irregular heartbeats that are life threatening. • 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. • A pacemaker may be helpful for some patients who experience reoccurring common faints that are associated with a very slow heart rate. Drugs are usually not very effective in treating patients with common faints. • Heart rhythm monitoring can be a good choice for patients with unexplained fainting who may have intermittent heart rhythm issues that cause fainting. • An athlete who has problems with fainting should have a heart assessment done by an experienced health care provider or specialist before returning to competitive sports. (Source: AHA Press Release, March 9, 2017) Dr KK Aggarwal National President IMA and HCFI

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