Cardiovascular assessment using carotid sinus massage, tilt-table testing, and implantable loop recorders increases the diagnostic yield for underlying causes of unexplained falls in older people.
Falls in older people can be caused by underlying cardiovascular disorders, either because of balance instability in persons with background gait and balance disorders, or because of amnesia for loss of consciousness during unwitnessed syncope. Pertinent investigations include a detailed history, 12-lead electrocardiography, lying and standing blood pressure, carotid sinus massage (CSM), head-up tilt, cardiac electrophysiological tests, and ambulatory blood pressure and heart rate monitoring, which includes external and internal cardiac monitoring. The presence of structural heart disease predicts an underlying cardiac cause. Conversely, the absence of either indicates that neurally mediated etiology is likely. CSM and tilt-table testing should be considered in patients with unexplained and recurrent falls. Holter monitoring over 24 hours has a low diagnostic yield. Early use of an implantable loop recorder may be more cost-effective. A dedicated investigation unit increases the likelihood of achieving positive diagnoses and significantly reduces hospital stay and health expenditure.
Tan et al. (Sun,) conducted a review in Falls and syncope. Cardiovascular assessment was evaluated. Cardiovascular assessment using carotid sinus massage, tilt-table testing, and implantable loop recorders increases the diagnostic yield for underlying causes of unexplained falls in older people.