Outcome of an integrated approach to the investigation of dizziness, falls and syncope, in elderly patients referred to a 'syncope' clinic

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Abstract

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 selected group of elderly patients referred to a 'syncope' clinic, the diagnostic yield was high. © 1993 British Geriatrics Society.

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Mcintosh, S., Costa, D. D., & Kenny, R. A. (1993). Outcome of an integrated approach to the investigation of dizziness, falls and syncope, in elderly patients referred to a “syncope” clinic. Age and Ageing, 22(1), 53–58. https://doi.org/10.1093/ageing/22.1.53

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