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Syncope in old people. The importance of multiparametric monitor in OBI evaluation
Author(s) -
Alessandro Riccardi,
Laura Pastorino,
Bruno Chiarbonello,
Luca Beatini,
Luca Corti,
Marina Castelli,
Roberto Lerza
Publication year - 2006
Publication title -
emergency care journal
Language(s) - English
Resource type - Journals
eISSN - 2282-2054
pISSN - 1826-9826
DOI - 10.4081/ecj.2006.5.30
Subject(s) - medicine , syncope (phonology) , asystole , emergency department , atrial fibrillation , etiology , atrial flutter , cardiology , cardiac monitoring , supraventricular tachycardia , implantable loop recorder , ventricular tachycardia , physical examination , tachycardia , psychiatry
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

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