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Syncope and neurocardiovascular instability 

Syncope and neurocardiovascular instability
Syncope and neurocardiovascular instability
Oxford Textbook of Geriatric Medicine (3 edn)

Rose Anne Kenny

and Conal Cunningham


The prevalence of syncope rises with age and is challenging because of atypical presentation, overlap with falls, and poor recall of events. Cardiac causes and multiple comorbidities are more common, and related morbidity and mortality are higher than in younger patients. Hence, a high index of suspicion for cardiovascular causes of falls and dual pathology will increase successful diagnosis and intervention. Age-related neurohumoral and physiological changes plus chronic diseases and medications often contribute to syncope. Orthostatic hypotension, carotid sinus syndrome, vasovagal syncope, postprandial syncope, sinus node disease, atrioventricular block, and ventricular tachycardia are other common causes. Management is often based on removing or reducing the predisposing or precipitating factors through medication adjustments, behavioural strategies, and more invasive cardiac interventions if indicated. It is often not possible to identify a single cause of syncope in older persons, hence apragmatic management of each diagnosis is recommended.

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