Guideline released on evaluation, management of syncope

The joint guideline from the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society is based on evidence published through October 2016.


The American College of Cardiology, the American Heart Association, and the Heart Rhythm Society released a joint guideline last week on the evaluation and management of patients with syncope.

The new recommendations, which were based on evidence published through October 2016, include the following:

  • Patients with syncope should undergo a detailed history and physical examination during their initial evaluation.
  • Resting 12-lead electrocardiogram (EKG) can be useful in the initial evaluation of syncope.
  • Patients who present with syncope and have a serious medical condition that could be related should be evaluated and/or treated in the hospital after the initial assessment is completed.
  • Continuous EKG monitoring is useful for patients with syncope of suspected cardiac cause who are admitted to the hospital for evaluation.
  • Certain tests, including routine laboratory testing, routine cardiac imaging (unless a cardiac issue is suspected), and carotid artery imaging, are not useful in evaluating syncope, unless there is a specific reason why additional evaluation is needed.
  • Exercise stress testing can be useful to establish causation in certain patients who experience syncope or presyncope during exertion.

Detailed treatment recommendations for cardiovascular conditions, including arrhythmic conditions, structural conditions, and inheritable arrhythmic conditions, are also included in the guideline, as are recommendations on reflex conditions (e.g., vasovagal syncope), orthostatic hypotension, dehydration and drugs, pseudosyncope, and special populations (e.g., children, elderly patients, athletes, and those with congenital heart disease).

The guideline, which was written in collaboration with the American College of Emergency Physicians and the Society for Academic Emergency Medicine, was published online March 9 by the Journal of the American College of Cardiology, Circulation, and HeartRhythm.