[Syncope in elderly patients--which studies are sensible?]

In the elderly the cause of a syncope often is difficult to elucidate. A prospective study at the Kantonsspital Liestal (Switzerland) confirmed that history and physical examination together with an ECG at rest are the most important diagnostic tools in the investigation of a syncope. Further investigations such as 24-hour ECG, echocardiography or tilt test should be restricted to situations where history and physical examination support the suspicion of rhythm disturbances or valvular disorder or a vasovagal mechanism. Thus, if an arrhythmia is suspected a 24-hour ECG may produce useful information. Implantable pacemakers are particularly successful in bradycardic arrhythmias. Echocardiography and Doppler-ECG allow to quantify the severity of an aortic stenosis. The insertion of a prosthetic aortic valve is successfully performed also in the elderly. Tilt testing may elucidate the neurocardiogenic mechanism of a vasovagal syncope or a hypersensitive carotis sinus. In such cases a pacemaker or appropriate medication may be indicated.