Η Συγκοπή στους Ηλικωμένους Παθοφυσιολογία- Αίτια-Διάγνωση- Θεραπεία
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.