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Age and Ageing 2000; 29: 501-504
© 2000, British Geriatrics Society

Research papers

A diagnostic service for eliciting carotid sinus hypersensitivity and vasovagal symptoms in a district general hospital

Michael Bacon and John A. H. Grunstein

Department of Medicine for Elderly People, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth PO6 3LY, UK

Abstract

Aim: to describe the technical, diagnostic and logistical problems encountered in a syncope and falls clinic in a district general hospital.

Methods: we have reviewed 157 consecutive patients and the problems encountered in their assessment at the clinic.

Results: 143 patients (91%) completed assessment, which included head-up tilt and carotid sinus massage. We reached a diagnosis in 75 of these (52%). Difficulties with continuous blood pressure monitoring caused testing to be abandoned in four cases and caused considerable delay (up to 30 min) in 45% of the rest. Eight patients (5%) refused consent for carotid sinus massage and two others had neurological sequelae. Some patients fulfilled diagnostic criteria on testing but remained asymptomatic, making an attributable diagnosis difficult. This was most noticable with vasodepressor carotid sinus hypersensitivity. The limited facilities in a district general hospital and the time-consuming nature of the testing resulted in a considerable delay between referral and assessment (58 days ± 25.9), which may adversely affect diagnostic yield.

Conclusions: syncope clinics have a role in the assessment of elderly people with recurrent syncope and unexplained falls. Enthusiasm for this approach has to be tempered with an awareness of the limitations of the tests involved and an appreciation of the logistical problems likely to be encountered in a district hospital.

Keywords: attributable diagnosis, carotid sinus hypersensitivity, carotid sinus massage, district hospital, vasovagal syncope


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This article has been cited by other articles:


Home page
 J. Neurol. Neurosurg. PsychiatryHome page
A M Humm and C J Mathias
Unexplained syncope--is screening for carotid sinus hypersensitivity indicated in all patients aged >40 years?
J. Neurol. Neurosurg. Psychiatry, November 1, 2006; 77(11): 1267 - 1270.
[Abstract] [Full Text] [PDF]


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