Complex Pathology of Cardiac Syncope in Old Patients

Abstract

Syncope is characterized by a transient and rapid loss of consciousness for a short duration, with full spontaneous recovery within minutes. Syncope causes up to 2% of all emergency medical consultations. The incidence of syncope is similar in men and women, is higher in old patients (slightly higher in old women). The prevalence of syncope is up to 23% for the institutionalized elderly. In elderly patients, syncope often presents atypically, such as with falls; these patients might also have difficulty recalling events. The true incidence and prevalence of syncope in elderly patients are expected to be higher than those estimated in most studies. The causes of syncope are highly age-dependent. Reflex or neurally mediated syncope is the most common cause, particularly in younger patients. As individuals age, orthostatic hypotension and cardiac syncope become more frequent. In elderly patients, neurally mediated syncope is the most prevalent form of syncope. Orthostatic syncope is more frequent in the elderly than in young patients. In the elderly, cardiac causes account for about 15% of all cases, and in about 10% of the cases, the origin of syncope is unknown. A combination of different etiologies is common in geriatric patients because many pathophysiologies coexist, including age-related physiological changes, co-morbidities (e.g., neurological pathologies), multiple medications (with interactions, or with lowering of BP and HR), malnutrition, sarcolepsy, and prolonged bed rest. The available clinical guidelines for the diagnosis, investigation, and treatment of syncope are insufficient to address syncope in elderly patients. A comprehensive geriatric approach that considers the functional and cognitive capacities of individuals along with the medical and psychosocial aspects would be more appropriate. Modern medicine can be used to treat syncope in some geriatric patients and should be offered whenever possible.