Syncope in old people. The importance of multiparametric monitor in OBI evaluation

Syncope in old people. The importance of multiparametric monitor in OBI evaluation

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Syncope is a common clinical entity, and it causes up to 3% of admission in the Emergency Department.The evaluation of syncope begins with a careful history, physical examination, and electrocardiography, with a correct identification of etiology at the presentation in up to 50% of cases.Moreover, the underlying cause of syncope remains unidentified in a elevated percentage of patients.The application of Standard Guidelines and the institution of the Observation Unit (OBI) with continuous monitoring improves patients management, chiefly in the geriatric population (> 65 years old).

In older patients the clinical features of syncope are less defined, and the medical history has a limited value.The management in the OBI of this opi the color that keeps on giving group of patient with continuous monitoring could become the best approach.The ECG monitoring can detect life-threatening arrhythmias in older patients with apparent non cardiac syncope.In the firs six months of 2005 the Emergency Department of the Ospedale San Paolo (Savona) evaluated 164 patients > 65 years old with diagnosis of syncope/pre-syncope.

During monitoring we detected events of arrhythmia in 12 patients (7,3%), including ventricular tachycardia in 2, atrial fibrillation in 4, paroxysmal atrial flutter in 2, paroxysmal supraventricular tachycardia in 1, asystole in 1 and third-degree atrioventricular block in 2 patients.We briefly describe 2 of this case: in read more both cases the first suggestion indicates a possible non cardiac etiology, but the subsequent monitoring shows episodes of potentially fatal arrhythmia.Both an early discharge and an in non-monitorized bed admission wouldn’t have preserved the two patient by a sudden cardiac death.