Influence of age and gender on the occurrence and presentation of reflex syncope

Romme, Jacobus J. C. M.; Dijk, Nynke van; Boer, Kimberly R.; Dekker, Lukas; Stam, Jan; Reitsma, Johannes B.; Wieling, Wouter

doi:10.1007/s10286-008-0465-0

Cited by 103 publications

(72 citation statements)

References 38 publications

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“…Symptoms and signs are of great importance also, but frequently more difficult to establish from the examination and often even absent, especially in elderly subjects [8,30]. Tables 2 and 3 provide a list of situational triggers and predisposing factors [10].…”

Section: Methodological Aspectsmentioning

confidence: 99%

Clinical history in management of suspected syncope: A powerful diagnostic tool

2014

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Section: Methodological Aspectsmentioning

confidence: 99%

Clinical history in management of suspected syncope: A powerful diagnostic tool

2014

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“…Contrary to observations for young women, clinical evidence supports the concept that orthostatic hypotension occurs less frequently in women ages 40 -60 yr (many of whom could be postmenopausal) (51). Investigations of men and women from 23-77 yr of age indicated that the heart rate response to tilt was reduced with aging, but vascular responses appeared to be enhanced to protect against low blood pressure (17,32).…”

mentioning

confidence: 85%

“…ORTHOSTATIC HYPOTENSION (a condition that sometimes leads to fainting) is an important and sometimes dangerous condition that particularly affects young women during daily life, as reflected by admission to emergency rooms (51). It has been speculated that female sex hormones might modulate reflex neural or vascular properties, resulting in the greater incidence of orthostatic hypotension in young women (5,14,15,52,69).…”

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confidence: 99%

Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men

Edgell

Robertson

Hughson

2012

Journal of Applied Physiology

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Edgell H, Robertson AD, Hughson RL. Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men. J Appl Physiol 112: 1482-1493, 2012. First published February 23, 2012 doi:10.1152/japplphysiol.01204.2011.-Increased incidence of orthostatic hypotension and presyncopal symptoms in young women could be related to hormonal factors that might be isolated by comparing cardiovascular and cerebrovascular responses to postural change in young and older men and women. Seven young women, 11 young men, 10 older women (Ͼ1 yr postmenopausal, no hormone therapy), and 9 older men participated in a supine-to-sit-to-stand test while measuring systemic hemodynamics, end-tidal PCO2, and blood flow velocity of the middle cerebral artery (MCA). Women had a greater reduction in stroke volume index compared with age-matched men (change from supine to standing: young women: Ϫ22.9 Ϯ 1.6 ml/m 2 ; young men: Ϫ14.4 Ϯ 2.4 ml/m 2 ; older women: Ϫ17.4 Ϯ 3.3 ml/m 2 ; older men: Ϫ13.8 Ϯ 2.2 ml/m 2 ). This was accompanied by offsetting changes in heart rate, particularly in young women, resulting in no age or sex differences in cardiac output index. Mean arterial pressure (MAP) was higher in older subjects and increased with movement to upright postures. Younger men and women had higher forearm vascular resistance that increased progressively in the upright posture compared with older men and women. There was no difference between sexes or ages in total peripheral resistance index. Women had higher MCA velocity, but both sexes had reduced MCA velocity while upright, which was a function of reduced blood pressure at the MCA and a significant reduction in end-tidal PCO2. The reductions in stroke volume index suggested impaired venous return in women, but augmented responses of heart rate and forearm vascular resistance protected MAP in younger women. Overall, these results showed significant sex and age-related differences, but compensatory mechanisms preserved MAP and MCA velocity in young women. cerebrovascular; sex; age; orthostatic ORTHOSTATIC HYPOTENSION (a condition that sometimes leads to fainting) is an important and sometimes dangerous condition that particularly affects young women during daily life, as reflected by admission to emergency rooms (51). It has been speculated that female sex hormones might modulate reflex neural or vascular properties, resulting in the greater incidence of orthostatic hypotension in young women (5,14,15,52,69). An additional indication of impaired orthostatic responses in women includes the observation that women have a greater propensity towards postural orthostatic tachycardia syndrome (18, 60).Contrary to observations for young women, clinical evidence supports the concept that orthostatic hypotension occurs less frequently in women ages 40 -60 yr (many of whom could be postmenopausal) (51). Investigations of men and women from 23-77 yr of age indicated that the heart rate response to tilt was reduced with aging, but vascular responses a...

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“…The VVS is responsible for 31 to 34% of the syncope cases in the elderly 47,48 In this population, it is especially important to perform the HUTT after the cardiac causes are ruled out, because the correct diagnosis and appropriate treatment can prevent falls and complications resulting from the syncope, such as fractures and subdural hematoma. In addition, the HUTT increases the chance of identifying carotid sinus hypersensitivity, which is linked with up to 20% of syncopes in the elderly 49 .…”

Section: When Is the Tilt Test Most Important?mentioning

confidence: 99%