(精编)【医学英文课件】 2017 ACC、AHA、HRS Guideline for the Evaluation and Management of Patients With Syncope.pptVIP

Early Repolarization Pattern COR LOE Recommendations IIb C-EO ICD implantation may be considered in patients with early repolarization pattern and suspected arrhythmic syncope in the presence of a family history of early repolarization pattern with cardiac arrest. III: Harm B-NR EPS should not be performed in patients with early repolarization pattern and history of syncope in the absence of other indications. Reflex Conditions 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope COR LOE Recommendations I C-EO Patient education on the diagnosis and prognosis of VVS is recommended. IIa B-R Physical counter-pressure maneuvers can be useful in patients with VVS who have a sufficiently long prodromal period. IIa B-R Midodrine is reasonable in patients with recurrent VVS with no history of hypertension, HF, or urinary retention. IIb B-R The usefulness of orthostatic training is uncertain in patients with frequent VVS. IIb B-R Fludrocortisone might be reasonable for patients with recurrent VVS and inadequate response to salt and fluid intake, unless contraindicated. Reflex Conditions Vasovagal Syncope IIb B-NR Beta blockers might be reasonable in patients 42 years of age or older with recurrent VVS. IIb C-LD Encouraging increased salt and fluid intake may be reasonable in selected patients with VVS, unless contraindicated. IIb C-LD In selected patients with VVS, it may be reasonable to reduce or withdraw medications that cause hypotension when appropriate. IIb C-LD In patients with recurrent VVS, a selective serotonin reuptake inhibitor might be considered. Vasovagal Syncope (cont.) Vasovagal Syncope Colors correspond to Class of Recommendation in Table 1. VVS indicates vasovagal syncope. Pacemakers in Vasovagal Syncope COR LOE Recommendation IIb B-R SR Dual-chamber pacing might be reasonable in a select population of patients 40 years of age or older with recurrent VVS and prolonged spontaneous pauses. SR indicated systematic review.