title: Geriatric Syncope and Cardiovascular Risk in the Emergency Department.
abstract: BACKGROUND
  Syncope is a transient loss of consciousness that is caused by a brief loss in generalized cerebral blood flow.
  
  
  OBJECTIVE
  This article reviews the background, epidemiology, etiologies, evaluation, and disposition considerations of geriatric patients with syncope, with a focus on cardiovascular risk.
  
  
  CONCLUSIONS
  Although syncope is one of the most common symptoms in elderly patients presenting to the emergency department, syncope causes in geriatric patients can present differently than in younger populations, and the underlying etiology is often challenging to discern. History, physical examination, and electrocardiography (ECG) have the greatest utility in evaluating syncope. Additional testing should be guided by history and physical examination. There are multiple scoring tools developed to aid in management and these are reviewed in the article. Common predictors that would indicate a need for further work-up include a history of cardiac or valvular disease (i.e., ventricular dysrhythmia, congestive heart failure), abnormal ECG, anemia or severe volume depletion (i.e., from a gastrointestinal bleed), syncope while supine or with effort, report of palpitations or chest pain, persistent abnormal vital signs, or family history of sudden death. With advancing age, cardiovascular morbidity plays a more frequent and important role in the etiology of syncope.
  
  
  CONCLUSIONS
  The syncope work-up should be tailored to the patient's presentation. Disposition should be based on the results of the initial evaluation and risk factors for adverse outcomes.
authors.affiliation: Department of Emergency Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts; Department of Emergency Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Nissa J
authors.initials: NJ
authors.lastname: Ali
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shamai A
authors.initials: SA
authors.lastname: Grossman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000493:pharmacokinetics; D001145:Arrhythmias, Cardiac / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications* / Q000503:physiopathology; D003244:Consciousness Disorders / Q000209:etiology; D003937:Diagnosis, Differential; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D005853:Geriatrics / Q000379:methods; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000493:pharmacokinetics; D013575:Syncope / Q000209:etiology*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000493:pharmacokinetics
chemical_list: D000959:Antihypertensive Agents; D011619:Psychotropic Drugs; D014665:Vasodilator Agents
keywords: cardiovascular risk; emergency medicine; geriatrics; presyncope; syncope