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[Iatrogenic syncopes and malaises].

C Duplantier1, B Courtat-Bailly, C Moreau

  • 1Service de cardiologie, hôpital Saint-Louis, 17019 La-Rochelle, France.

Annales De Cardiologie Et D'Angeiologie
|December 18, 2004
PubMed
Summary
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Adverse drug reactions frequently cause syncope (fainting) in elderly patients, particularly from antihypertensives and alpha-blockers. This study highlights the need for systematic drug review in diagnosing syncope, especially in older adults.

Area of Science:

  • Geriatric Medicine
  • Clinical Pharmacology
  • Cardiology

Context:

  • Syncope and presyncope are common, with adverse drug reactions (ADRs) being a known but under-investigated cause.
  • Elderly patients (≥70 years) are particularly susceptible to ADRs, complicating diagnosis and management.
  • A systematic approach is crucial for identifying drug-induced syncope, especially in patients with pre-existing cardiovascular conditions.

Purpose:

  • To systematically investigate the role of specific drugs in causing syncope or presyncope in a hospital setting.
  • To assess the frequency and types of ADRs contributing to syncope in elderly patients.
  • To identify drug classes commonly implicated in iatrogenic syncope.

Summary:

  • A six-year study identified 75 patients with probable or possible ADR-induced syncope, predominantly in elderly females (average age 78).

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  • Hypotension was the most common ADR (79%), often linked to cardiovascular drugs like ACE inhibitors and diuretics, but also uroselective alpha-1 blockers.
  • Other ADRs included arrhythmias and metabolic disorders, underscoring the impact of polypharmacy in this population.

    • Impact:

    • This research confirms the significant role of antihypertensive medications in iatrogenic syncope among the elderly.
    • It highlights uroselective alpha-1 adrenergic blocking drugs as a less commonly reported but important cause of drug-induced syncope.
    • Findings emphasize the necessity of routine ADR screening in elderly patients presenting with syncope to improve diagnostic accuracy and patient safety.