STATE-OF-THE-ART PAPER
Vasovagal Syncope in the Older Patient
Maw Pin Tan, BMedSci, BMBS, MRCP*,1 and
Steve W. Parry, MBBS, PhD, FRCP*, ,*
* Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom
Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Manuscript received May 16, 2007;
revised manuscript received November 8, 2007,
accepted November 12, 2007.
* Reprint requests and correspondence: Dr. Steve W. Parry, Falls and Syncope Service, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, United Kingdom. (Email: steve.parry{at}nuth.nhs.uk).
Vasovagal syncope (VVS) has been diagnosed with increasing frequency in older patients since the head-up tilt-table test (HUT) was described over 2 decades ago. The incidence and prevalence of VVS in this age group remains unknown. Older individuals are more likely to display a dysautonomic hemodynamic pattern with a predominantly hypotensive response during HUT. The positivity rates to passive and isoprotenerol-provoked HUT are reduced with age, but positivity rates for glyceryl-trinitrate-induced HUT are comparable with younger subjects. Few studies into treatment strategies have included older subjects. This is a review of the existing literature on the epidemiology, clinical characteristics, diagnostic tools, and treatment strategies for VVS in older patients, highlighting important areas for future research.
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Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | ATP = adenosine triphosphate | | GTN = glyceryl trinitrate | | HF-HRV = high-frequency-heart rate variability | | HUT = head-up tilt-table test(ing) | | VVS = vasovagal syncope |
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