Syncope: The Big Picture - Antonio Raviele website · Syncope: The Big Picture Antonio Raviele, MD,...
45
Syncope: The Big Picture Antonio Raviele, MD, FESC, FHRS XV World Congress of Arrhythmias, Beijing, China - 17-20 September, 2015 ALFA – Alliance to Fight Atrial fibrillation, Mestre – Venice, Italy
Transcript of Syncope: The Big Picture - Antonio Raviele website · Syncope: The Big Picture Antonio Raviele, MD,...
Syncope: The Big Picture
Antonio Raviele, MD, FESC, FHRS
XV World Congress of Arrhythmias, Beijing, China - 17-20 September, 2015
ALFA – Alliance to Fight Atrial fibrillation, Mestre – Venice, Italy
Eur Heart J 2009; 30: 2631-2671
Heart Rhythm 2015; 12(6): e41-e63
Europace 2015; June 24; Epub before print
www.escardio.org/guidelines
Transient loss of consciousness of
- rapid onset,
- short duration,
- spontaneous complete recovery
Syncope / Definition
Eur Heart J 2009; 30: 2631-2671
www.escardio.org/guidelines
Underlying mechanism
Transient global cerebral hypoperfusion
Syncope
Eur Heart J 2009; 30: 2631-2671
www.escardio.org/guidelines
Syncope Non-syncopal Attacks
Transient Loss of Consciousness
Eur Heart J 2009; 30: 2631-2671
Transient LOC / Initial Evaluation
Careful history
Physical examination
Orthostatic BP measurements
Electrocardiogram
Eur Heart J 2009; 30: 2631-2671
Initial Evaluation
Question #1
Syncope or non syncopal attack ?
Eur Heart J 2009; 30: 2631-2671
Initial Evaluation
Question #2
What is the cause of syncope ?
Eur Heart J 2009; 30: 2631-2671
www.escardio.org/guidelines
Certain Diagnosis Uncertain Diagnosis
www.escardio.org/guidelines
Criteria suggestive of high risk of cardiovascular events or death
www.escardio.org/guidelines
Cardiac cause likely or suspected
yes no
Cardiac evaluation -Echocardiogram -Exercise test -ECG monitoring / ILR -EP study -Coro Angiography
NM evaluation -Carotid sinus massage -Tilt testing -ATP test -ILR
Laboratory investigations
Eur Heart J 2009; 30: 2631-2671
www.escardio.org/guidelines
Reflex Cause likely or suspected
yes no
Cardiac evaluation -Echocardiogram -Exercise test -ECG monitoring / ILR -EP study -Coro Angiography
NM evaluation -Carotid sinus massage -Tilt testing -ATP test
Laboratory investigations
Eur Heart J 2009; 30: 2631-2671
www.escardio.org/guidelines Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
www.escardio.org/guidelines Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
www.escardio.org/guidelines Europace 2015; June 24; Epub before print
A facility featuring a standardized approach to the
diagnosis and management of T-LoC and related
symptoms, with dedicated staff and access to
appropriate diagnostics and therapies.
Syncope Unit / Definition
Kenny RA et al. Europace 2015; June 24; Epub before print
Provide state-of-the-art guideline-based assessment of syncopal
patients in order to risk-stratify them, obtain an aetiological
diagnosis, assess prognosis, and initiate adequate therapy.
Perform directly the core laboratory tests and have preferential
access to hospitalization, diagnostic tests, and therapeutic
procedures.
Reduce hospitalizations and costs related to syncope management.
Syncope Unit / Objectives
Syncope Unit / Conclusions
The Introduction of Syncope Units has led to a more appropriate
use of diagnostic tests, a reduction of undiagnosed cases, a
decrease of hospitalization and a considerable improvement in
diagnostic yield and cost-effectiveness (that is cost per reliable
diagnosis), with resultant more efficient management of patients
with syncope.
Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
Framework for a comprehensive management of patients with T-LOC of certain/suspected syncopal nature referred to the SU. Core evaluation and therapy depend on each model of care
delivery, with a minimum acceptable set described in Consensus Statement 1.
Rose Anne Kenny et al. Europace 2015;europace.euv115
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].
www.escardio.org/guidelines Sheldon RS et al. Heart Rhythm 2015; 12(6): e41-e63
