Key points of the 2017 acc/AHA/hrs guideline for the evaluation and management of patients with syncope

Abstract

The article presents key points of published in March 2017, Guideline for the Evaluation and Management of Patients With Syncope (A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society). This document contains summary and analysis of evidence base and accumulated experience in this field and reflect further development of the problem of the management of adult and pediatric patients with suspected syncope. Traditionally, the basis of diagnostic algorithm of these patients has been primary examination, and in the present guideline one can find strengthening of the importance of anamnestic criteria, and supplementation of ECG criteria of arrhythmic syncope. At the same time, the diagnostic value of provocative tests has been revised, and the class of indications for these tests has been lowered. According to the guideline, along with diagnosis of the cause of fainting, risk stratification of short-and long-term adverse outcomes has a key value. The guideline summarizes latest achievements in the treatment of fainting in sarcoidosis, arrhythmogenic right ventricular dysplasia, primary arrhythmic heart diseases, orthostatic hypotension, and reflex-mediated syncope. Despite orientation on specific properties of medical care in the USA, the guideline can be useful to practical physicians in choice of the best strategy of diagnosis and treatment of syncope in each individual case.