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Cited by 24Cardiovascular Syncope and Autonomic DisordersBalance, Gait, and Falls PreventionVestibular and auditory disorders

Carotid sinus syndrome is common in very elderly patients undergoing tilt table testing and carotid sinus massage because of syncope or unexplained falls

Paling, David, Vilches-Moraga, Arturo, Akram, Qasim, Atkinson, Oliver, Staniland, John, Paredes-Galán, Emilio·2011·Aging Clinical and Experimental Research
DOI 10.1007/bf03324968
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Abstract

Background and aims Although the incidence of falls and syncope increase with age, the underlying mechanisms are not fully understood, particularly in very old patients. We report diagnostic outcomes of tilt table and carotid sinus massage (TT/CSM) testing in a population of older old subjects (82% over 80 years of age) referred for TT/CSM from a falls clinic for assessment of syncope or unexplained falls. Methods Prospective observational study between January 1, 2001 and January 1, 2005 involving 290 consecutive subjects undergoing TT/CSM testing according to European Society of Cardiology guidelines for the diagnosis and management of syncope. Results Combination of TT/CSM provided a positive result in 62% of subjects, and was significantly more likely to be positive in subjects over the age of 80 (68% vs 50%, p=0.001). Carotid sinus syndrome (CSS) was the most common diagnosis, and was significantly more common in subjects over 80 (48% vs 34%, p=0.022) particularly due to a higher incidence of mixed CSS (16% vs 7%, p=0.023). There was no significant difference in the diagnosis of subjects referred due to falls and those reporting syncope (p=0.93). No cardiovascular or neurological adverse events occurred. Conclusions In our cohort of very elderly patients, the diagnostic accuracy of tilt testing and carotid sinus massage was high and adverse incidents absent when testing was indicated by a geriatrician experienced in the assessment of falls and syncope. We advocate the us…

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  • The incidence of syncope in older adults is high.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [668]

  • The diagnosis of syncope in older adults is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [668]

  • The differential diagnosis of syncope in older adults is broad.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [668]

  • Secondary morbidity from syncope in older adults is high because of comorbidities, physical injury, and frailty.

    “The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [668]

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Authors
Paling, D., Vilches-Moraga, A., Akram, Q., Atkinson, O., Staniland, J., & Paredes-Galán, E.
Affiliations
UCL Queen Square Institute of Neurology (GB)
ORCID
Venue
Aging Clinical and Experimental Research
Publisher
Springer Science and Business Media LLC
Published
2011-08
Volume
23
Issue
4
Pages
304-308
ISSN
  • 1594-0667 (ISSN-L)
  • 1720-8319
DOI
10.1007/bf03324968
OpenAlex
W2087210614
Cited by
24
References
6
Citations by year
2025: 1 · 2018: 1 · 2017: 8 · 2016: 3 · 2015: 1 · 2014: 4 · 2013: 4 · 2012: 1
FWCI
2.95
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Aging Clinical and Experimental Research (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
carotid sinus syndrome, syncope, unexplained falls, very elderly patients, tilt table test, carotid sinus massage, diagnostic accuracy, geriatric assessment, falls clinic
MeSH terms
Accidental Falls, Aged, Aged, 80 and over, Carotid Sinus, Humans, Middle Aged, Prospective Studies, Syncope, Tilt-Table Test

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