Syncope in the Very Elderly: Diagnosis and Treatment

Syncope in the very elderly is common. It could be dangerous and disabling, and the cause may be difficult to diagnose. Any condition that reduces blood pressure either by peripheral vasodilatation or from decrease in cardiac output may produce syncope. The cause of syncope could be determined in less than 50% of the patients following history, examination and electrocardiogram. Broadly, syncope can be categorized as cardiac or noncardiac. The cardiac causes can be subdivided into mechanical and electrical. The aim of diagnostic evaluation of syncope in the elderly is firstly to identify those who are likely to have life-threatening events or increased risk of death and secondly to prevent recurrent falls. Clinical history and examination are the most valuable tools in determining the cause of syncope. Treatment would be directed at the specific cause. The chapter provides an overview of our understanding of this perplexing condition, the pathophysiology, its causes, evaluation and management.