title: Carotid sinus syndrome is common in very elderly patients undergoing tilt table testing and carotid sinus massage because of syncope or unexplained falls.
abstract: OBJECTIVE
  Although the incidence of falls and syncope increase with age, the underlying mechanisms are not fully understood, particularly in very old patients. We report diagnostic outcomes of tilt table and carotid sinus massage (TT/CSM) testing in a population of older old subjects (82% over 80 years of age) referred for TT/CSM from a falls clinic for assessment of syncope or unexplained falls.
  
  
  METHODS
  Prospective observational study between January 1, 2001 and January 1, 2005 involving 290 consecutive subjects undergoing TT/CSM testing according to European Society of Cardiology guidelines for the diagnosis and management of syncope.
  
  
  RESULTS
  Combination of TT/CSM provided a positive result in 62% of subjects, and was significantly more likely to be positive in subjects over the age of 80 (68% vs 50%, p=0.001). Carotid sinus syndrome (CSS) was the most common diagnosis, and was significantly more common in subjects over 80 (48% vs 34%, p=0.022) particularly due to a higher incidence of mixed CSS (16% vs 7%, p=0.023). There was no significant difference in the diagnosis of subjects referred due to falls and those reporting syncope (p=0.93). No cardiovascular or neurological adverse events occurred.
  
  
  CONCLUSIONS
  In our cohort of very elderly patients, the diagnostic accuracy of tilt testing and carotid sinus massage was high and adverse incidents absent when testing was indicated by a geriatrician experienced in the assessment of falls and syncope. We advocate the use of TT/CSM testing as part of a comprehensive falls/syncope assessment for the diagnostic evaluation of older patients presenting with unexplained falls and/or syncope in whom structured assessment has not identified a cause for their symptoms.
authors: UCL Institute of Neurology, London, UK.
authors: David
authors: D
authors: Paling
authors: Arturo
authors: A
authors: Vilches-Moraga
authors: Qasim
authors: Q
authors: Akram
authors: Oliver
authors: O
authors: Atkinson
authors: John
authors: J
authors: Staniland
authors: Emilio
authors: E
authors: Paredes-Galán
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D002346:Carotid Sinus / Q000502:physiology* / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013575:Syncope / Q000150:complications* / Q000209:etiology* / Q000503:physiopathology*; D018667:Tilt-Table Test / Q000009:adverse effects*