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185The Value of Head-Up Tilt in Addition to Electrocardiograph Interpretation in Evaluating Syncope

Background: European Society of Cardiology guidelines emphasise the necessity of history taking, physical examination and electrocardiograph (ECG) in syncope assessment (1). However, in clinical practice exclusion of Orthostatic Hypotension (OH) in an individual presenting with syncope is also a first line investigation. Methods: This was a retrospective analysis of ECG and Head-up tilt (HUT) results on all inpatients, referred to the syncope laboratory, over a 3 month period. ECG tracings were obtained through a software programme ‘Therefore’ in the Emergency Department (ED) and HUT results were retrieved from the syncope laboratory. Results: 75 consecutive inpatients with a strong clinical suspicion for the presence of OH after their initial assessment in the ED were referred to the syncope laboratory. The average age was 75 years. 58/75(77%) had ECG tracings available for review. Of these, 27(47%) had an abnormal ECG with a possible explanation for their syncopal symptoms e.g. bradycardia or heart block. Those with an abnormal ECG had a higher average age than those with a normal ECG, 80.5 and 70.4 years respectively. On review of the Head-up Tilt results 14/75(19%) patients demonstrated OH. We could not retrieve an ECG on 2/14(14%) of these patients. 2/14(14%) patients had a normal ECG but 10/14(71%) patients with OH had an abnormal ECG namely atrial fibrillation, heart block and bradycardia. No acute cardiac arrhythmia or ischaemia was detected. Conclusions: Careful ECG interpretation is required for initial syncope evaluation and to assess patients’ suitability for HUT particularly in older people who have comorbidities. However ECG abnormalities are present in almost 30% of older adults and may not be the sole explanation for an episode of presyncope/syncope (2). A possible cardiac cause should not negate the need to exclude OH particularly in frail older adults who may have dual pathology.