Syncope

The prevalence of syncope increases with advancing age and is associated with significant morbidity and mortality. Age per se should not be considered a barrier to the assessment and treatment of syncope. On the contrary, older patients with syncope require an early and detailed investigation and management. The diagnosis within this population can be complex due to atypical presentations, amnesia for events, absence of witnesses, and overlap with other clinical presentations as falls. Falls unrelated to specific medical or accidental conditions are defined unexplained and may underlie a syncopal mechanism. A comprehensive assessment of comorbid conditions and drug regimen is necessary. A standardized guidelines-based approach on neurally mediated syncope, through active standing test, Carotid Sinus Massage and Tilt Testing, is well tolerated in older patients. Advances in cardiac monitoring devices have increased the diagnostic yield for cardiac syncope. Treatment of syncope ranges from simple conservative measures to permanent cardiac pacing.