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ACCF/AHA/NHLBI 2009 Expert Consensus Document On 1 for Task and Society ¶ACC/AHA the Heartthe American 7. , # 01 † January 2 Elect in . Chair Syncope Joint Representative. Chair , /DC1 /DC2 Chair- /- Vice Chair Vice 9/- Coordinating Committee Immediate Past Chair Ikonomidis, MD, PhD, FAHA PhD, MD, Ikonomidis, and the Heart Rhythm Society Clinical Policy Approval Committee on behalf of the , Roopinder Kaur Sandhu, MD, MPH‡ Kaur MD, Roopinder Sandhu, MD‡ Sorajja, Dan FACEP║ MPP, MD, Sun, C. Benjamin FAHA‡¶ FACC, MSc, MD, W. Yancy, Clyde Mark S. Link, MD, FACC‡ MD, Link, S. Mark FHRS*‡ FAHA, FACC, MD, Brian Olshansky, FHRS*§ MSc, FACC, MD, Raj, Satish R. nital Electrophysiology Society nital Electrophysiology Board Trustees of Federico Gentile, MD, FACC MD, Federico Gentile, FAHA MD, Gidding, Samuel Mark A. Hlatky, MD, FACC John FAHA MD, FACC, Joglar, José FAHA RN, PhD, J. Pressler, Susan PhD MD, Wijeysundera, N. Duminda ACEP and SAEM SAEM ACEP and rdiology rdiology ║ .0000000000000499 Patients With Guideline for the Evaluation and CIR COMMITTEE MEMBERS* # Practice Guidelines the AmericanCollege of Emergency Physicians Academic Emergency Medicine Foundation, American Heart Association, Inc., and Heart Rhythm Society for detailed information. †ACC/AHA Task Force on Clinical Practice Guidelines Practice Guidelines †ACC/AHA Clinical Task Force on information. detailed for #Former Task Force member; current member during the writing effort. the writing during member current Force member; Task #Former ACC/AHA TASKFORCE MEMBERS HRS Representative. Representative. HRS WRITING Glenn N. Levine, MD, FACC, FAHA FACC, MD, Levine, Glenn N. -Kuang Shen, MD, FACC, FAHA, FHRS, FHRS, FAHA, FACC, MD, Shen, -Kuang Robert S. Sheldon, MD, PhD, FHRS, FHRS, PhD, MD, Sheldon, S. Robert Patrick T. O’Gara, MD, FACC, FAHA, Win Guideline Management of Management Jonathan L. Halperin, MD, FACC, FAHA, FAHA, FACC, MD, Halperin, L. Jonathan ACC/AHA/HRS Khatib, MD, MHS, FACC, FAHA FACC, MHS, Khatib, MD, - Endorsed the and Pediatric by Conge HA HA § Representative. 2017 Task Force on ClinicalTask Force Forman, MD, FACC, FAHA‡ A Report of the American College of Cardiology/American Heart Association of American the of Report A College Cardiology/American Executive Committee, and the Heart Rhythm Society Society Rhythm Heart the and Committee, Executive K, et al. Ralph G. Brindis, MD, MPH, MACC MPH, MD, Brindis, Ralph G. FACC MD, Cigarroa, E. Joaquin FAHA PhD, Curtis, H. Lesley Lee A. Fleisher,MD, FACC, FAHA Sana M. Al M. Sana AACC PharmD, MS, K.Kim Birtcher, FAHA FACC, Bozkurt, PhD, MD, Biykem - Developed inDeveloped Collaboration With Blair P. Grubb, MD, FACC§ MD, Grubb, Blair P. FHRS*‡ FACC, MBA, MD, Hamdan, H. Mohamed FHRS*§ Krahn, MD, D. Andrew Mitchell I. Cohen, MD, FACC, FHRS‡ FACC, MD, Cohen, Mitchell I. E. Daniel FHRS‡ FAHA, MS, FACC, MD, Goldberger, D. Zachary David G. Benditt, MD, FACC, FHRS*‡ FACC, MD, Benditt, G. David Force on Performance Measures Liaison. Liaison. Measures Performance Force on of Ca the approvedCollege American by document This was and Science Advisory Heart the Association American Trustees, Boardof Association The Comprehensive online RWI Data Supplement table available is thiswith article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/ © 2017 by the American College American © the of 2017 by Cardiology The Data online Supplement is available thiswith article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIR.000000000000049 *Writing committee members are requiredrecuse to themselves votingfrom on sections to their specificwhich relationships 1 Appendix see apply; may industry with Liaison. ‡ACC/A 2017 ACC/AHA/HRS Syncope Shen W Shen Downloaded from http://circ.ahajournals.org/ by guest on April 12, 2017 Shen W-K, et al. 2017 ACC/AHA/HRS Syncope Guideline The American Heart Association requests that this document be cited as follows: Shen W-K, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW. 2017 ACC/AHA/HRS 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. Circulation. 2017;:–. DOI: 10.1161/CIR.0000000000000499. This article has been copublished in the Journal of the American College of Cardiology and Heart Rhythm. Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (professional.heart.org), and the Heart Rhythm Society (www.hrsonline.org). A copy of the document is available at http://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 843-216-2533 or e-mail [email protected]. Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.” Downloaded from Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page. http://circ.ahajournals.org/ (Circulation. 2017;000:e000–e000. DOI: 10.1161/CIR.0000000000000499.) © 2017 by the American College of Cardiology Foundation, the American Heart Association, Inc., and the Heart Rhythm Society. Circulation is available at http://circ.ahajournals.org by guest on April 12, 2017 © 2017 by the American College of Cardiology Foundation, American Heart Association, Inc., and Heart Rhythm Society 2 Shen W-K, et al. 2017 ACC/AHA/HRS Syncope Guideline Table of Contents Preamble .................................................................................................................................................................. 5 1. Introduction ......................................................................................................................................................... 8 1.1. Methodology and Evidence Review ......................................................................................................... 8 1.2. Organization of the Writing Committee ................................................................................................... 8 1.3. Document Review and Approval .............................................................................................................. 8 1.4. Scope of the Guideline .............................................................................................................................. 9 2. General Principles ............................................................................................................................................. 11 2.1. Definitions: Terms and Classification .................................................................................................... 11 2.2. Epidemiology and Demographics ........................................................................................................... 12 2.3. Initial Evaluation of Patients With Syncope ........................................................................................... 13 History and Physical Examination: Recommendation ....................................................................... 14 Electrocardiography: Recommendation ............................................................................................. 15 Risk Assessment: Recommendations................................................................................................. 16 Downloaded from Disposition After Initial Evaluation: Recommendations ................................................................... 19 3. Additional Evaluation and Diagnosis ............................................................................................................... 21 3.1. Blood Testing: Recommendations .......................................................................................................... 22 3.2. Cardiovascular Testing ........................................................................................................................... 23 Cardiac Imaging: Recommendations ................................................................................................. 24 http://circ.ahajournals.org/ Stress Testing: Recommendation ....................................................................................................... 25 Cardiac Monitoring: Recommendations ............................................................................................ 25 In-Hospital Telemetry: Recommendation .......................................................................................... 28 Electrophysiological Study: Recommendations ................................................................................ 29 Tilt-Table Testing: Recommendations .............................................................................................. 30 3.3. Neurological Testing..............................................................................................................................
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