Vasovagal syncope in the older person: differences in presentation between older and younger patients

Abstract

in our large study population, VVS was more common in older patients. The clinical presentation differed significantly between the two groups. Older patients were less likely to give a typical history and therefore clinicians need to have a high index of suspicion when evaluating the older patient presenting with collapse or unexplained falls.

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.…”

“…Cognitive impairment is also frequently present in older adults, even in those without a formal diagnosis of dementia, [688][689][690] and this too can reduce the accuracy of recall of the clinical event. [666][667][668][669]673,686 …”

Syncope in the Older Person

“…50 Similarly, the classic provoking factors of prolonged standing, posture change, or hot environments are less common. 7 In contrast to younger fainters, the older patient with VVS is less likely to report both total or near loss of consciousness and more likely to present with unexplained falls. 7 The patient in question had no remembered prodrome, but during tilt table testing, clearly identified a short-lived feeling of strangeness and heat of particular import for future abortive maneuvers in real-life fainting.…”

“…7 In contrast to younger fainters, the older patient with VVS is less likely to report both total or near loss of consciousness and more likely to present with unexplained falls. 7 The patient in question had no remembered prodrome, but during tilt table testing, clearly identified a short-lived feeling of strangeness and heat of particular import for future abortive maneuvers in real-life fainting. Tilt table testing has been criticized for diagnostic purposes, 46 but its usefulness in showing prodromal symptoms in patients with poorly remembered or unrecognized premonitory symptoms should not be underestimated.…”

“…7 Typical vasovagal syncope (VVS), mediated by emotional stress such as severe pain or instrumentation, as seen in younger adults, is rarely seen in older adults. Also, VVS in younger adults is not generally associated with other cardiovascular or neurologic disease.…”