Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic.
Sixty-five consecutive elderly patients (mean age 78 years) referred to a 'syncope' clinic over a six-month period were prospectively studied. Initial evaluation included ambulatory electrocardiography, carotid sinus massage before and after atropine and prolonged head-up tilt. Diagnostic criteria for causes of syncope were assigned at the beginning of the study. Overall, a diagnosis was attributed to symptoms in 92% of patients; overlap was present in a quarter. Diagnoses were cardioinhibitory carotid sinus syndrome (CSS; 5%), vasodepressor CSS (26%), mixed CSS (14%), orthostatic hypotension (32%), vasodepressor vasovagal syncope (11%), cardiac arrhythmia (21%), epilepsy (9%), cerebrovascular disease (6%) and others (12.5%). Sixty per cent of patients with vasodepressor CSS also had orthostatic hypotension or vasodepressor vasovagal syncope suggesting a common aetiology. Using an integrated approach incorporating head-up tilt and carotid sinus massage in a selected group of elderly patients referred to a 'syncope' clinic, the diagnostic yield was high.
McIntosh
S
S
Department of Geriatric Medicine, Royal Victoria Infirmary, Newcastle upon Tyne.
Da Costa
D
D
Kenny
R A
RA
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002346:Carotid Sinus / Q000503:physiopathology; D004244:Dizziness / Q000209:etiology* / Q000503:physiopathology; D004827:Epilepsy / Q000150:complications / Q000503:physiopathology; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000150:complications / Q000503:physiopathology; D010348:Patient Care Team; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology; D013577:Syndrome; D014630:Vagus Nerve / Q000503:physiopathology