Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly

Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Backgr...

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Autores principales:	Rafanelli M, Morrione A, Landi A, Ruffolo E, Chisciotti VM, Brunetti MA, Marchionni N, Ungar A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	syncope elderly neuromediated diagnosis. Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/fca72982c2904cc380ed998c9ea07342
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spelling	oai:doaj.org-article:fca72982c2904cc380ed998c9ea073422021-12-02T01:32:29ZNeuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly1178-1998https://doaj.org/article/fca72982c2904cc380ed998c9ea073422014-02-01T00:00:00Zhttps://www.dovepress.com/neuroautonomic-evaluation-of-patients-with-unexplained-syncope-inciden-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Background: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT), carotid sinus massage (CSM), or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. Methods: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram) was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. Results: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was between vasovagal syncope and orthostatic hypotension (15.8%); 42.9% of patients aged 80 years or older had a complex diagnosis, for which age was the strongest predictor. Conclusion: Neuroautonomic evaluation is useful in older patients with unexplained syncope after the initial evaluation. A complex neurally mediated diagnosis is frequent in older people. Our results suggest that complete neuroautonomic evaluation should be done particularly in older patients. Keywords: syncope, elderly, tilt testing, carotid sinus massage, blood pressure, neurally mediated diagnosisRafanelli MMorrione ALandi ARuffolo EChisciotti VMBrunetti MAMarchionni NUngar ADove Medical Pressarticlesyncopeelderlyneuromediated diagnosis.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 333-339 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	syncope elderly neuromediated diagnosis. Geriatrics RC952-954.6
spellingShingle	syncope elderly neuromediated diagnosis. Geriatrics RC952-954.6 Rafanelli M Morrione A Landi A Ruffolo E Chisciotti VM Brunetti MA Marchionni N Ungar A Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
description	Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Background: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT), carotid sinus massage (CSM), or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. Methods: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram) was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. Results: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was between vasovagal syncope and orthostatic hypotension (15.8%); 42.9% of patients aged 80 years or older had a complex diagnosis, for which age was the strongest predictor. Conclusion: Neuroautonomic evaluation is useful in older patients with unexplained syncope after the initial evaluation. A complex neurally mediated diagnosis is frequent in older people. Our results suggest that complete neuroautonomic evaluation should be done particularly in older patients. Keywords: syncope, elderly, tilt testing, carotid sinus massage, blood pressure, neurally mediated diagnosis
format	article
author	Rafanelli M Morrione A Landi A Ruffolo E Chisciotti VM Brunetti MA Marchionni N Ungar A
author_facet	Rafanelli M Morrione A Landi A Ruffolo E Chisciotti VM Brunetti MA Marchionni N Ungar A
author_sort	Rafanelli M
title	Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
title_short	Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
title_full	Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
title_fullStr	Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
title_full_unstemmed	Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
title_sort	neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/fca72982c2904cc380ed998c9ea07342
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Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly

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