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Syncope in the Elderly

Syncope in the Elderly. Vital signs = AF, 56, 118/49, 14, 96%Physical examination atraumatic, JVP normal, bilateral CBs, few crackles at the bases, abd. and ext. exam benign.What is your differential diagnosis and treatment plan? . Teaching Points. What is the underlying pathophysiologic mechanism

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Syncope in the Elderly

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    1. Syncope in the Elderly 79 yo F s/p syncope History of diabetes, CAD, s/p stent, HTN, AF, PVD, on multiple medications, including insulin, metoprolol, and norvasc Felt “dizzy” and had witnessed syncopal episode. No seizure or incontinence noted. No significant head injury. No focal neurological complaints.

    2. Syncope in the Elderly Vital signs = AF, 56, 118/49, 14, 96% Physical examination atraumatic, JVP normal, bilateral CBs, few crackles at the bases, abd. and ext. exam benign. What is your differential diagnosis and treatment plan?

    3. Teaching Points What is the underlying pathophysiologic mechanism of syncope? Decrease in blood flow to the reticular activating system 5-15 seconds of significantly decreased blood flow can result in syncope

    4. Teaching Points What are the age-related changes in elderly patients that make them more prone to syncope? Multifactorial Decreased cerebral blood flow (25%) due to decreased cardiac output and vascular compliance Decreased ability to compensate for CV insults Autonomic dysfunction, such as blunted B-adrenergic response

    5. Teaching Points Age-related changes in elderly patients that make them more prone to syncope (con’t.)? Lower plasma renin and aldosterone levels (salt wasting) Impaired thirst mechanisms (dehydration) More susceptible to orthostatic hypotension More susceptible to infections Polypharmacy, drug effects

    6. Teaching Points Cardiac syncope in the elderly 2 times more prevalent in the elderly Responsible for 34% of syncopal events in the elderly 21-30% mortality compared to 6-12% for non-cardiac Electrical (dysrhythmias, pacer malfunction) vs. mechanical events (valvular disease, MI, CM, pulmonary HTN)

    7. References Glasby, J: Syncope, in Meldon S (ed): Geriatric Emergency Medicine. New York, McGraw-Hill, 2004. Kapoor WN: Syncope in older persons. J Am Geriat Soc. 42:426, 1994. Lipsitz LA: Syncope in the elderly patient. Hosp Pract 21:33, 1986.

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