Sandbox: Syncope

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.