Sandbox: Syncope: Difference between revisions
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| bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || bgcolor="LightGreen" | A detailed history and physical examination should be performed in patients with syncope. | | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || bgcolor="LightGreen" | A detailed history and physical examination should be performed in patients with syncope. | ||
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| bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || In the initial evaluation of patients with syncope, a resting 12-lead electrocardiogram (ECG) is useful. | | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || bgcolor="LightGreen" | In the initial evaluation of patients with syncope, a resting 12-lead electrocardiogram (ECG) is useful. | ||
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| bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || Evaluation of the cause and assessment for the short- and long-term morbidity and mortality risk of syncope are recommended. | | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || bgcolor="LightGreen" | Evaluation of the cause and assessment for the short- and long-term morbidity and mortality risk of syncope are recommended. | ||
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| bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | B-NR || Use of risk stratification scores may be reasonable in the management of patients with syncope. | | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | B-NR || bgcolor="LemonChiffon" | Use of risk stratification scores may be reasonable in the management of patients with syncope. | ||
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| colspan="3" | '''Recommendations for Disposition After Initial Evaluation''' | | colspan="3" | '''Recommendations for Disposition After Initial Evaluation''' | ||
|- | |- | ||
| bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || Hospital evaluation and treatment are recommended for patients presenting with syncope who have a serious medical condition potentially relevant to the cause of syncope identified during initial evaluation. | | bgcolor="LightGreen" | I || bgcolor="LightBlue" | B-NR || bgcolor="LightGreen" | Hospital evaluation and treatment are recommended for patients presenting with syncope who have a serious medical condition potentially relevant to the cause of syncope identified during initial evaluation. | ||
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| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C-LD || It is reasonable to manage patients with presumptive reflex-mediated syncope in the outpatient setting in the absence of serious medical conditions. | | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | C-LD || bgcolor="LemonChiffon" | It is reasonable to manage patients with presumptive reflex-mediated syncope in the outpatient setting in the absence of serious medical conditions. | ||
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| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-R || In intermediate-risk patients with an unclear cause of syncope, use of a structured ED observation protocol can be effective in reducing hospital admission. | | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-R || bgcolor="LemonChiffon" | In intermediate-risk patients with an unclear cause of syncope, use of a structured ED observation protocol can be effective in reducing hospital admission. | ||
|- | |- | ||
| bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | C-LD || It may be reasonable to manage selected patients with suspected cardiac syncope in the outpatient setting in the absence of serious medical conditions. | | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | C-LD || bgcolor="LemonChiffon" | It may be reasonable to manage selected patients with suspected cardiac syncope in the outpatient setting in the absence of serious medical conditions. | ||
|- | |- | ||
| colspan="3" | '''Recommendations for Blood Testing''' | | colspan="3" | '''Recommendations for Blood Testing''' | ||
|- | |- | ||
| bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-NR || Targeted blood tests are reasonable in the evaluation of selected patients with syncope identified on the basis of clinical assessment from history, physical examination, and ECG. | | bgcolor="LemonChiffon" | IIa || bgcolor="LightBlue" | B-NR || bgcolor="LemonChiffon" | Targeted blood tests are reasonable in the evaluation of selected patients with syncope identified on the basis of clinical assessment from history, physical examination, and ECG. | ||
|- | |- | ||
| bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | C-LD || Usefulness of brain natriuretic peptide and high-sensitivity troponin measurement is uncertain in patients for whom a cardiac cause of syncope is suspected. | | bgcolor="LemonChiffon" | IIb || bgcolor="LightBlue" | C-LD || bgcolor="LemonChiffon" | Usefulness of brain natriuretic peptide and high-sensitivity troponin measurement is uncertain in patients for whom a cardiac cause of syncope is suspected. | ||
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| bgcolor="LightCoral" | III-No Benefit || bgcolor="LightBlue" | B-NR || Targeted blood tests are reasonable in the evaluation of selected patients with syncope identified on the basis of clinical assessment from history, physical examination, and ECG. | | bgcolor="LightCoral" | III-No Benefit || bgcolor="LightBlue" | B-NR || bgcolor="LightCoral" | Targeted blood tests are reasonable in the evaluation of selected patients with syncope identified on the basis of clinical assessment from history, physical examination, and ECG. | ||
|} | |} | ||
Revision as of 00:30, 30 October 2017
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Recommendation for History and Physical Examination
| COR | LOE | RECOMMENDATION |
|---|---|---|
| I | B-NR | A detailed history and physical examination should be performed in patients with syncope. |
| I | B-NR | In the initial evaluation of patients with syncope, a resting 12-lead electrocardiogram (ECG) is useful. |
| I | B-NR | Evaluation of the cause and assessment for the short- and long-term morbidity and mortality risk of syncope are recommended. |
| IIb | B-NR | Use of risk stratification scores may be reasonable in the management of patients with syncope. |
| Recommendations for Disposition After Initial Evaluation | ||
| I | B-NR | Hospital evaluation and treatment are recommended for patients presenting with syncope who have a serious medical condition potentially relevant to the cause of syncope identified during initial evaluation. |
| IIa | C-LD | It is reasonable to manage patients with presumptive reflex-mediated syncope in the outpatient setting in the absence of serious medical conditions. |
| IIa | B-R | In intermediate-risk patients with an unclear cause of syncope, use of a structured ED observation protocol can be effective in reducing hospital admission. |
| IIb | C-LD | It may be reasonable to manage selected patients with suspected cardiac syncope in the outpatient setting in the absence of serious medical conditions. |
| Recommendations for Blood Testing | ||
| IIa | B-NR | Targeted blood tests are reasonable in the evaluation of selected patients with syncope identified on the basis of clinical assessment from history, physical examination, and ECG. |
| IIb | C-LD | Usefulness of brain natriuretic peptide and high-sensitivity troponin measurement is uncertain in patients for whom a cardiac cause of syncope is suspected. |
| III-No Benefit | B-NR | Targeted blood tests are reasonable in the evaluation of selected patients with syncope identified on the basis of clinical assessment from history, physical examination, and ECG. |