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A 75-year-old Woman with Syncope

Derick M Todd MB, ChB, Clinical Fellow, Arrhythmia Service,
University of Western Ontario, London, ON.
Andrew D Krahn MD, Associate Professor, Cardiology, Department of Medicine,
University of Western Ontario, London, ON.

Introduction
A prompt and accurate diagnosis of syncope in the elderly is important in reducing morbidity1 and mortality, and for maintaining independence.2,3 The risk of a serious cardiac arrhythmia as the underlying cause for syncope is increased in the elderly, especially in those with an abnormal resting electrocardiogram and/or impairment of left ventricular function.4 The key to the diagnosis most often lies in the history from the patient and an eyewitness account. Detecting underlying heart disease by history, clinical examination and a resting 12-lead ECG are crucial in directing further investigation and treatment.5 Patients considered likely to have a cardiovascular cause for syncope have a significantly increased mortality rate compared to patients with a non-cardiovascular cause or who remain undiagnosed.6 The following case report is intended to illustrate some of these issues.