In the multi-centre Evaluation of Guidelines in Syncope Study 2 group (EGSYS-2 Study), Chiara Mussi and colleagues from emergency departments in Italy applied ESC guidelines to the management of 465 patients arriving in casualty with syncope.
Updated 2004 ESC guidelines on the management (diagnosis and treatment) of syncope
The updated 2004 ESC guidelines on the management (diagnosis and treatment) of syncope say that in addition to a careful history, physical examination and standard electrocardiogram, every patient should have blood pressure measurements both in the sitting or lying position, and then again after standing for one to three minutes. OH was defined as a reduction of systolic blood pressure of at least 20 mmHg in the transition from lying to standing, or a systolic blood pressure less than 90 mm Hg.
Results show that syncope due to OH was present in nearly 10% of the study population. In addition, the study demonstrated that patients with OH syncope were significantly older (p<0.001), more likely to be affected by hypertension (p=0.024), coronary heart disease (p=0.049), Parkinson’s disease (p=0.0007), other cardiac conditions (p=0.023), and neurological conditions (p=0.006). Moreover, in multivariate analysis the use of beta-blockers (p=0.015), nitrates (p=0.035), and diuretics (p=0.029) were related to OH syncope, independent of age, sex, abnormal ECG, and other cardiac and neurological diseases.
Quick, easy and extremely low cost
“Syncope due to orthostatic hypotension is frequently caused by drug interactions,” said Mussi. “When introducing new drugs, doctors need to remember to start slow and go slow. Introducing routine screening for orthostatic hypotension is quick, easy and extremely low cost since it can be performed with a standard sphygmomanometer. Doctors all too often search for more dangerous (but not so frequent) causes of syncope, and miss out on this simple first line evaluation.” She added that it was important to identify OH in elderly populations since it was often implicated in falls resulting in disability.
Abstract No: 82853, Chiara Mussi. “Incidence of orthostatic hypotension as a cause of syncope in emergency departments: the EGSYS 2 Study.”