Syncope in the Older Person

2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society

“…35,45,[666][667][668][669][670][671][672][673][674][675] The vulnerability of older adults to syncope increases because of age-associated cardiovascular and autonomic changes, decreased fluid conservation, 45,671,[676][677][678] and an increased probability of developing multiple concurrent morbidities (with their associated pharmacological treatments) that can overwhelm homeostasis. In many instances, a syncopal event in an older adult is multifactorial, with many predisposing factors present simultaneously.…”

“…109,679,680 Although some of the risk is attributable to the aspects of syncope described in this guideline, among older adults such risks are usually compounded by multiple morbidities and frailty, which add to age-related vulnerability to syncope, 671,681,682 and by the physical injuries associated with falls, collisions, or trauma, which more commonly result from syncope in old age. 670 Furthermore, recurrent syncope can lead to nursing home admission and a devastating loss of independence.…”

Clinical history in management of suspected syncope: A powerful diagnostic tool

“…2. Older subjects: In contrast, cardiac causes of syncope in the older patient increase progressively with increasing age and, therefore, are an important consideration in every case [27].…”

Individualized and Multidisciplinary Approach of Syncope in the elderly: a case report

“…We can classify syncope by the main cause: cardiac causes (arrhythmias, valvular disease); neurally me-diated (vasovagal syncope, carotid sinus syndrome, situational syncope) and orthostatic hypotension. [3][4] In general, vasovagal attacks are the most common cause of syncope, followed by cardiac etiologies.…”

“…4 The pathophysiology of neuromediated syncope is still unclear, it is most likely due to a combination of several factors: changes in the autonomic nervous system, hormonal changes, coexistence of multiple pathologies and polypharmacy. 3 Vasovagal syncope is classically preceded by prodromes (pallor, sweating, and nausea) at young age, but may not be so in the elderly. 7 This cause is more common in a healthy young patient.…”