David Brill
The European Society of Cardiology has updated its guidelines to facilitate the diagnosis and management of syncope – a common clinical challenge for GPs and specialists alike.
A novel diagnostic workflow promotes early risk stratification – enabling prompt treatment for those who need it and avoiding unnecessary therapy for those who don’t.
New emphasis is also placed on prolonged monitoring for patients with benign but recurrent syncope, which can adversely affect quality of life.
The guidelines reflect a multidisciplinary collaboration and have been endorsed by leading European and American societies, ranging from emergency medicine to geriatrics and neurology.
The authors recommend that initial evaluation be performed to divide patients into syncope or non-syncopal loss of consciousness. Genuine cases of syncope should then be divided into certain and uncertain diagnosis – with risk stratification performed for the latter.
“In the vast majority of the population the cause of syncope is something very benign and it has no consequences for the patient. But in some, syncope can be the herald of a severe cardiac arrhythmia or even the first manifestation of a future sudden death, so it is important to recognize in which patients it is severe and in which patients it is benign,” said task force chairman Professor Angel Moya, of the University Hospital Vall d’Hebron in Barcelona, Spain.
The authors have also revised the definition of syncope itself, such that reduced cerebral blood flow is now a prerequisite for diagnosis. They define syncope as: “a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery.”
“Without this diagnostic addition the definition of syncope becomes wide enough to include other disorders such as epileptic seizures and concussion. In fact [it] would be nothing more than ‘loss of consciousness,’ irrespective of mechanism and duration,” said Moya.
Syncope is a common problem, thought to affect up to 50 percent of people at least once in their lifetime. The three most common types identified in the guidelines are reflex syncope, orthostatic hypotension and cardiac syncope.
Reflex syncope results from an alteration of the cardiovascular reflexes that control circulation, leading to hypotension and reduced cerebral blood flow. Orthostatic hypertension is typically a recurring event resulting from circulatory abnormalities, which may also cause other symptoms such as dizziness and palpitations. Cardiac syncope is more serious, and is usually a sign of an underlying arrhythmia which should be treated.
The new guidelines – developed in collaboration with the European Heart Rhythm Association, the Heart Failure Association and the Heart Rhythm Society – were published online in the European Heart Journal. [2009 Aug 27; Epub ahead of print]
A novel diagnostic workflow promotes early risk stratification – enabling prompt treatment for those who need it and avoiding unnecessary therapy for those who don’t.
New emphasis is also placed on prolonged monitoring for patients with benign but recurrent syncope, which can adversely affect quality of life.
The guidelines reflect a multidisciplinary collaboration and have been endorsed by leading European and American societies, ranging from emergency medicine to geriatrics and neurology.
The authors recommend that initial evaluation be performed to divide patients into syncope or non-syncopal loss of consciousness. Genuine cases of syncope should then be divided into certain and uncertain diagnosis – with risk stratification performed for the latter.
“In the vast majority of the population the cause of syncope is something very benign and it has no consequences for the patient. But in some, syncope can be the herald of a severe cardiac arrhythmia or even the first manifestation of a future sudden death, so it is important to recognize in which patients it is severe and in which patients it is benign,” said task force chairman Professor Angel Moya, of the University Hospital Vall d’Hebron in Barcelona, Spain.
The authors have also revised the definition of syncope itself, such that reduced cerebral blood flow is now a prerequisite for diagnosis. They define syncope as: “a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery.”
“Without this diagnostic addition the definition of syncope becomes wide enough to include other disorders such as epileptic seizures and concussion. In fact [it] would be nothing more than ‘loss of consciousness,’ irrespective of mechanism and duration,” said Moya.
Syncope is a common problem, thought to affect up to 50 percent of people at least once in their lifetime. The three most common types identified in the guidelines are reflex syncope, orthostatic hypotension and cardiac syncope.
Reflex syncope results from an alteration of the cardiovascular reflexes that control circulation, leading to hypotension and reduced cerebral blood flow. Orthostatic hypertension is typically a recurring event resulting from circulatory abnormalities, which may also cause other symptoms such as dizziness and palpitations. Cardiac syncope is more serious, and is usually a sign of an underlying arrhythmia which should be treated.
The new guidelines – developed in collaboration with the European Heart Rhythm Association, the Heart Failure Association and the Heart Rhythm Society – were published online in the European Heart Journal. [2009 Aug 27; Epub ahead of print]
No comments:
Post a Comment