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The changing face of orthostatic and neurocardiogenic syncope with age – Source: QJM, An International Journal of Medicine, Mar 7, 2011

  [ 6 votes ]   [ Discuss This Article ]
By J Cooke, et al. • • March 13, 2011

[Note: syncope involves a dysregulation of the autonomic nervous system or heart abnormality where blood pressure & heart rate do not adjust normally to match the body’s changing requirements, and blood flow to the brain is reduced temporarily (as in rising to an upright position), causing ‘faintness’.]

Aim: Reports of the outcomes of syncope assessment across a broad spectrum of ages in a single population are scarce. It is our objective to chart the varying prevalence of orthostatic and neurocardiogenic syncope (NCS) as a patient ages.

Methods: This was a retrospective study. All consecutive patients referred to a tertiary referral syncope unit over a decade were included. Patients were referred with recurrent falls or orthostatic intolerance. Tilt tests and carotid sinus massage (CSM) were performed in accordance with best practice guidelines.

A total of 3,002 patients were included (1,451 short tilt, 127 active stand, 1,042 CSM and 382 prolonged tilt). Ages ranged from 11 to 91 years with a median (IQR) of 75 (62-81) years. There were 1,914 females; 1,088 males.

Orthostatic hypotension (OH) was the most commonly observed abnormality (test positivity of 60.3%). Those with OH had a median (IQR) age of 78 (71-83) years. Symptomatic patients were significantly younger than asymptomatic (P=0.03).

Neurocardiogenic syncope (NCS) demonstrated a bimodal age distribution:

- Of 194 patients with carotid sinus hypersensitivity, the median age (IQR) was 77 (68-82) years.

-Those with vasovagal syncope (n=80) had a median (IQR) age of 30 (19-44) years.

• There were 57 patients with isolated postural orthostatic tachycardia syndrome [POTS]. Of the total patients, 75% were female. They had a median (IQR) age of 23 (17-29) years.

Conclusion: We have confirmed, in a single population, a changing pattern in the etiology of syncope as a person ages. The burden of disease is greatest in the elderly.

Source: QJM, An International Journal of Medicine, Mar 7, 2011. PMID: 21382922, by Cooke J, Carew S, Costelloe A, Sheehy T, Quinn C, Lyons D. Mid-Western Regional Hospital (Department of Medicine, Division of Ageing & Therapeutics) & Graduate Entry Medical School, University of Limerick, Limerick, Ireland. [Email:]

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