Νικόλαος Καυκάς
Διευθυντής Καρδιολογικής Κλινικής ΓΝΑ ΚΑΤ
Ελένη Σεϊτανίδη
Ειδικευόμενη, Καρδιολογική Κλινική ΓΝΑ ΚΑΤ
Περίληψη
A syncopal event in an older adult is multifactorial, with many predisposing factors present simultaneously. The incidence is high; the differential diagnosis is broad and the diagnosis is imprecise. The management of syncope in older adults is particularly challenging: The most common causes of syncope in the elderly are orthostatic hypotension (OH), reflex syncope, especially carotid sinus syndrome (CSS) and cardiac arrhythmias. Hospitalization related to OH increases progressively with age: 4.2% of 65- to 74-year-old patients and 30.5% of patients older than 75 years. OH is not always reproducible in older adults (particularly medication and age-related). Therefore, orthostatic BP appraisal should be repeated, preferably in the morning and/or promptly after syncope. Carotid sinus massage is particularly important. Cardioinhibitory CSS is the recognized cause of symptoms in up to 20% of elderly patients with syncope. Carotid sinus hypersensitivity of predominantly vasodepressor form is equally prevalent, but its potential role in syncope is much less clear. Due to the high frequency of arrhythmias, an implantable loop recorder may be especially useful in the elderly with unexplained syncope.
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