[Syncopes in patients of advanced age]

This review covers the various etiologies and therapeutic possibilities of syncopes in the elderly. The importance of normal blood pressure and the danger of hypotension are stressed: The frequently occurring vascular stenoses may become especially dangerous if pre-stenotic pressure drops as a consequence of orthostatic dysregulation or of inadequate treatment of hypertension. Orthostatic dysregulation--a common phenomenon in old age--is possibly due to a diminished activity of the baroreceptor reflexes or to the pooling of blood in the venous system and/or to the diminution of blood volume by therapeutic procedures (diuretics) or by bed rest. The cautious use of antihypertonics, of diuretics and of psychopharmacological drugs in the correctly adjusted dose is essential in the management of these pathophysiological mechanisms in the elderly. The orthostatic hypotension--a condition that has to be treated in the old aged--can be managed by supportive treatment such as education of baroreceptor reflexes, compression of the lower extremities, and correction of electrolyte and water disturbances. Vasoconstrictors have to be used additionally with great care to adjust the correct dose of the combination of dihydroergotamine and sympathomimetics individually.