Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic

Age Ageing. 1993 Jan;22(1):53-8. doi: 10.1093/ageing/22.1.53.


Sixty-five consecutive elderly patients (mean age 78 years) referred to a 'syncope' clinic over a six-month period were prospectively studied. Initial evaluation included ambulatory electrocardiography, carotid sinus massage before and after atropine and prolonged head-up tilt. Diagnostic criteria for causes of syncope were assigned at the beginning of the study. Overall, a diagnosis was attributed to symptoms in 92% of patients; overlap was present in a quarter. Diagnoses were cardioinhibitory carotid sinus syndrome (CSS; 5%), vasodepressor CSS (26%), mixed CSS (14%), orthostatic hypotension (32%), vasodepressor vasovagal syncope (11%), cardiac arrhythmia (21%), epilepsy (9%), cerebrovascular disease (6%) and others (12.5%). Sixty per cent of patients with vasodepressor CSS also had orthostatic hypotension or vasodepressor vasovagal syncope suggesting a common aetiology. Using an integrated approach incorporating head-up tilt and carotid sinus massage in a selected group of elderly patients referred to a 'syncope' clinic, the diagnostic yield was high.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls* / prevention & control
  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / complications
  • Arrhythmias, Cardiac / physiopathology
  • Blood Pressure / physiology
  • Carotid Sinus / physiopathology
  • Dizziness / etiology*
  • Dizziness / physiopathology
  • Epilepsy / complications
  • Epilepsy / physiopathology
  • Follow-Up Studies
  • Hemodynamics / physiology
  • Humans
  • Hypotension, Orthostatic / complications
  • Hypotension, Orthostatic / physiopathology
  • Ischemic Attack, Transient / complications
  • Ischemic Attack, Transient / physiopathology
  • Patient Care Team*
  • Syncope / etiology*
  • Syncope / physiopathology
  • Syndrome
  • Vagus Nerve / physiopathology