Document Detail

Syncope in the elderly.
MedLine Citation:
PMID:  12616401     Owner:  NLM     Status:  MEDLINE    
Syncope is defined as a self-limited loss of consciousness, usually combined with falling due to the inability to maintain postural tone. The underlying mechanism is a transient global cerebral hypoperfusion. The aetiology essentially includes cardiac disorders (structured heart disease or arrhythmias), neurally-mediated reflex syndromes, orthostatic hypotension and carotid sinus syndrome. History and physical examination will lead to the diagnosis in up to 50%. The most important step is to differentiate patients with heart disease from others, since the mortality of these patients is doubled. Echocardiography, Holter-monitoring and electrophysiological study are useful to approach this population. In patients with suspected neurally-mediated syncope (vasovagal syncope) tilt testing is indicated. Treatment depends on the aetiology. The diagnostic work-up and the therapeutic approach of patients with syncope are outlined. For patients with vasovagal syncope conventional therapeutic strategies include an increased salt/fluid intake, moderate exercise training, tilt-sleeping or tilt-training. Beta-blockers failed to show efficacy in a number of randomised trials. Recently, pacemaker implantation in selected patients with recurrent vasovagal syncopical episodes showed a significant increase in syncope-free survival, compared to no therapy and compared to beta-blocker therapy. In contrast to the increased mortality risk for patients with cardiac syncope, patients with vasovagal syncope have a benign prognosis.
J Wöhrle; M Kochs
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Zeitschrift für Gerontologie und Geriatrie     Volume:  36     ISSN:  0948-6704     ISO Abbreviation:  Z Gerontol Geriatr     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-03-04     Completed Date:  2003-08-05     Revised Date:  2011-08-18    
Medline Journal Info:
Nlm Unique ID:  9506215     Medline TA:  Z Gerontol Geriatr     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  2-9     Citation Subset:  IM    
Department of Cardiology, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm, Germany.
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MeSH Terms
Accidental Falls / prevention & control*
Diagnosis, Differential
Ischemic Attack, Transient / etiology,  prevention & control
Risk Factors
Syncope / etiology*,  prevention & control
Tilt-Table Test

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