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


Submitted: 17 February 2013
Accepted: 17 February 2013
Published: 20 October 2006
Abstract Views: 784
PDF: 2014
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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 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 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.

Riccardi, A., Pastorino, L., Chiarbonello, B., Beatini, L., Corti, L., Castelli, M., & Lerza, R. (2006). Syncope in old people. The importance of multiparametric monitor in OBI evaluation. Emergency Care Journal, 2(5), 30–34. https://doi.org/10.4081/ecj.2006.5.30

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