title: A diagnostic service for eliciting carotid sinus hypersensitivity and vasovagal symptoms in a district general hospital.
abstract: OBJECTIVE
  to describe the technical, diagnostic and logistical problems encountered in a syncope and falls clinic in a district general hospital.
  
  
  METHODS
  we have reviewed 157 consecutive patients and the problems encountered in their assessment at the clinic.
  
  
  RESULTS
  143 patients (91%) completed assessment, which included head-up tilt and carotid sinus massage. We reached a diagnosis in 75 of these (52%). Difficulties with continuous blood pressure monitoring caused testing to be abandoned in four cases and caused considerable delay (up to 30 min) in 45% of the rest. Eight patients (5%) refused consent for carotid sinus massage and two others had neurological sequelae. Some patients fulfilled diagnostic criteria on testing but remained asymptomatic, making an attributable diagnosis difficult. This was most noticeable with vasodepressor carotid sinus hypersensitivity. The limited facilities in a district general hospital and the time-consuming nature of the testing resulted in a considerable delay between referral and assessment (58 days +/- 25.9), which may adversely affect diagnostic yield.
  
  
  CONCLUSIONS
  syncope clinics have a role in the assessment of elderly people with recurrent syncope and unexplained falls. Enthusiasm for this approach has to be tempered with an awareness of the limitations of the tests involved and an appreciation of the logistical problems likely to be encountered in a district hospital.
authors.affiliation: Department of Medicine for Elderly People, Queen Alexandra Hospital, Cosham, Portsmouth, UK.
authors.forename: M
authors.initials: M
authors.lastname: Bacon
authors.forename: J A
authors.initials: JA
authors.lastname: Grunstein
mesh_terms: D000368:Aged; D002346:Carotid Sinus / Q000503:physiopathology*; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D013575:Syncope / Q000175:diagnosis*; D019462:Syncope, Vasovagal / Q000175:diagnosis*