Medicine for the Elderly

Question 1

Definition - Carotid Sinus Syndrome

Answer 1

Abnormal activation of the carotid sinus resulting in cerebral hypo perfusion

Question 2

Cause - Carotid Sinus Syndrome

Answer 2

Hypersensitive carotid sinus baroreceptors

Question 3

Presentation - Carotid Sinus Syndrome

Answer 3

Bradycardia
Hypotension
Syncope
Falls

Question 4

Diagnosis - Carotid Sinus Syndrome

Answer 4

Carotid sinus massage
Tilt table testing if massage negative but history suggests CSS

Question 5

Management - Carotid Sinus Syndrome

Answer 5

Lifestyle changes = avoid triggers, adequate fluids
Some cases = cardiac pacing or surgery

Question 6

Definition - Orthostatic Hypotension

Answer 6

A fall in systolic BP of at least 20mmHg and/or a fall in diastolic BP of at least 10mmHg within 3 minutes of standing

Question 7

Presentation - Orthostatic Hypotension

Answer 7

Blurred vision
Dizziness
Falls
Syncope
Lightheadedness on standing

Question 8

Diagnosis - Orthostatic Hypotension

Answer 8

Clinical diagnosis supposed by lying/standing BP testing

Question 9

Conservative Management - Orthostatic Hypotension

Answer 9

Remove triggers
Waterloading
Increase salt intake
Leg elevation when sitting

Question 10

Medical Management + When to Commence - Orthostatic Hypotension

Answer 10

Fludrocortisone or midodrine

Consider when conservative measures have failed

Question 11

Three Types - Orthostatic Hypotension

Answer 11

Classic
Initial = decrease immediately on standing which rapidly corrects
Progressive