ESC launches new guidelines on syncope
The European Society of Cardiology (ESC) has launched new guidelines on syncope (the transient loss of consciousness caused by reduced blood flow to the brain).
Syncope is very common with approximately 50% of people having at least one syncopal event during their lifetime. The most common type is vasovagal syncope, commonly known as fainting, which has many triggers including fear, shock, seeing blood, or prolonged standing. The challenge for doctors is to identify the minority of patients whose syncope is caused by a potentially deadly heart problem.
Dr Angel Moya, Task Force Co-chairperson, said: “Syncope is very common and is usually not life-threatening. We now have more tools to help us clarify the diagnosis and cause of syncope so that patients with benign forms can be reassured and those at risk of sudden cardiac death can receive treatment.”
The guidelines recommend a new algorithm for emergency departments to stratify patients and discharge those at low risk. Patients at intermediate or high risk should receive diagnostic tests in the emergency department or an outpatient syncope clinic.
The document emphasises the value of video recording in hospital or at home to improve diagnosis. It recommends that friends and relatives use their smartphones to film the attack and recovery. Dr Moya said: “There are clinical clues, such as the duration of the loss of consciousness, whether the patient’s eyes are open or closed, and jerky movements, that can help distinguish between syncope, epilepsy, or other conditions.”
Another diagnostic tool is the implantable loop recorder, a small device inserted underneath the skin of the chest that records the heart’s electrical signals. The guidelines recommend extending its use for diagnosis in patients with unexplained falls, suspected epilepsy, or recurrent episodes of unexplained syncope and a low risk of sudden cardiac death. A new section has been added to the guidelines, as an addendum, with practical instructions for doctors on how to perform and interpret diagnostic tests.
Brignole M, Moya A, de Lange F et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018 https://doi.org/10.1093/eurheartj/ehy037 - https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehy037/4939241