From the Guidelines
Syncope in elderly females is most commonly caused by orthostatic hypotension, reflex syncope, and cardiac arrhythmias, and evaluation should prioritize identifying and treating the underlying cause to reduce morbidity, mortality, and improve quality of life. The causes of syncope in elderly females can be multifactorial, including age-related changes, medication side effects, and underlying medical conditions 1. According to the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope, orthostatic hypotension, reflex syncope, and cardiac syncope are common causes of syncope in the elderly 1.
Key Causes of Syncope
- Orthostatic hypotension: a sudden drop in blood pressure upon standing, often due to age-related autonomic dysfunction, dehydration, or medication side effects 1
- Reflex syncope: including vasovagal syncope and carotid sinus hypersensitivity, which can be triggered by emotional stress, pain, or other factors 1
- Cardiac arrhythmias: such as bradycardia or tachycardia, which can be caused by underlying heart disease or other conditions 1
Evaluation and Management
Evaluation of syncope in elderly females should include a thorough medication review, orthostatic blood pressure measurements, ECG, and possibly echocardiogram, Holter monitoring, or tilt-table testing depending on clinical suspicion 1. Management focuses on treating the underlying cause, which may involve medication adjustments, adequate hydration, compression stockings for orthostatic hypotension, or cardiac interventions for structural heart disease 1. The 2017 ACC/AHA/HRS guideline recommends a comprehensive and multidisciplinary approach to assess for multiple morbidities, frailty, trauma, and other dimensions of health pertinent to diagnosis and management in older adults 1.
Importance of Prompt Evaluation
Elderly patients experiencing syncope should be evaluated promptly as it may indicate serious underlying conditions and carries an increased risk of fall-related injuries 1. The risk of hospitalization and death related to syncope is higher in older adults, and recurrent syncope can lead to nursing home admission and a devastating loss of independence 1. Therefore, prompt and thorough evaluation and management of syncope in elderly females is crucial to reduce morbidity, mortality, and improve quality of life.
From the Research
Causes of Syncope in Elderly Female
The causes of syncope in elderly females can be attributed to various factors, including:
- Age-related physiological impairments in heart rate and blood pressure, and alterations in cerebral blood flow 2
- Multi-morbidity and polypharmacy, which increase susceptibility to syncope 2
- Cardiac causes, such as arrhythmias, which are the most common cardiac causes of syncope 3
- Orthostatic hypotension, which can be easily detected and managed with simple measures or drug treatments 4
Common Types of Syncope
There are three main types of syncope:
- Reflex syncope
- Syncope due to orthostatic hypotension
- Cardiac syncope 4
Diagnostic Evaluation
A thorough history and physical examination, including orthostatic assessment, are crucial for making the diagnosis of syncope 5
- A 12-lead electrocardiogram (ECG) is the only instrumental test recommended for the initial evaluation of patients with suspected syncope 3
- ECG diagnostic criteria and findings suggestive of cardiac syncope can help identify patients with high likelihood of cardiac syncope due to arrhythmic or cardiopulmonary disorder 3
Management and Treatment
Prompt assessment and early targeted intervention are recommended for patients with syncope 2