© 1993 Oxford University Press
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Outcome of an Integrated Approach to the Investigation of Dizziness, Falls and Syncope, in Elderly Patients Referred to a ‘Syncope’ Clinic
Syncope Clinic, Department of Geriatric Medicine Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
Address correspondence to Dr R. A. Kenny
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.
Received May 9, 1992;
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