First Syncope Guideline Released

Gale Scott

Fainting is common, but how should physicians treat it?

Syncope, commonly called fainting, is caused by low blood pressure resulting in an insufficient supply of oxygenated blood to the brain.

Since this can happen for a variety of reasons, some of them serious, the American College of Cardiology with the American Heart Association and the Heart Rhythm Society have created a guideline on how physicians should treat patients who experience syncope.

The guideline is the first for the condition.

It was published online March 9 in the Journal of the American College of Cardiology, Circulation, and HeartRhythm.

The chair of the writing group was Win-Kuang Shen, MD, (photo) an internist and cardiologist at the Mayo Clinic’s facility in Phoenix, Arizona.

“This is very important because fainting impacts thousands of people every day,” Shen said. “Now that we have these guidelines, physicians and clinicians will be able to make better-informed decisions and this will contribute to improved patient outcomes.”

Among the recommendations:

If a patient faints, doctors should do a detailed history and physical examination during the patient’s initial evaluation.

Physicians should inform patients that common fainting is not life-threatening though it is worrisome and can interfere with the quality of a patient’s life.

Taking an electrocardiogram can help pinpoint the cause of fainting when it is a sign of a heart condition.

When a patient has a serious medical condition that could have triggered the syncope, he or she should be evaluated and treated at a hospital after an initial assessment.

The guideline also advises physicians that certain tests will not be useful and should not be used.

These include routine laboratory testing, cardiac imaging like an MRI or CTscan (unless an underlying cardiac issue is suspected) and carotid artery or head imaging unless there is a specific reason for such an evaluation.

Implantable cardioverter defibrillators can be helpful if patients faint because they have life-threatening irregular heartbeats.

Beta blockers can be a good choice—the particulars are spelled out in detail in the guideline.

Some patients will need to restrict their exercise.

Pacemakers can be helpful if recurring fainting episodes are due to a slow heart rate but drugs are not usually very effecting in treating patients with common faints.

An athlete who has problems with fainting should have a heart assessment by someone experienced in doing that, or a specialist, before returning to competitive sports.

“Studies show that in the US, about one-third to half the population faints at some point in their lifetime. That means there is a very good chance these guidelines will either affect you directly or someone you know,” Shen said, adding “Therefore, having these guidelines is not only good for the clinicians using them, but for everyone.”

The American College of Emergency Physicians collaborated in drawing up the guidelines, as did the Society for Academic Emergency Medicine.

The article with the full guidelines is entitled “2017/ACC/AHA/HRS Guideline for the Evaluation and Management of Syncope.”

The ACC is a 52,000-member medical society. The AHA, based in Dallas, is the nation’s largest non-profit dedicated to fighting heart disease and stroke.

The Heart Rhythm Society is based in Washington, DC and has more than 5,800 heart rhythm professionals in more than 72 countries.