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Better clinical evaluation of syncope

Professor Stephen Harrap, Institution: Melbourne Health

2018 Vanguard Grant

Years funded: 2019-2020


Fainting, also known as transient loss of consciousness or syncope is a common problem necessitating hospital admission, especially in the elderly. Most causes are cardiovascular, usually related to low blood pressure (BP). Typically, the fall in BP occurs just on standing and will sometimes, but not always persist. Patients with transient dizziness on standing raise the suspicion of low BP, but it is very difficult to detect a brief (but significant) early fall in BP (known as initial orthostatic hypotension – IOH) with standard techniques.

As a result, the correct diagnosis of IOH can be missed, and patients can be subjected to expensive and unnecessary investigations and treatment can be delayed or misdirected. An accurate diagnosis of IOH is not only important in relation to the syncope, but IOH is often a clue to underlying cardiovascular disease and the longer term risk of death from cardiovascular causes. In patients admitted for diagnosis of syncope we shall add to existing diagnostic pathways a new clinical technology that measures the cardiovascular profile continuously and non-invasively.

 We shall assess whether this new method can detect IOH reliably, where it is presently missed by current standard techniques. We shall also assess whether the additional information regarding the output of the heart and the tone of the blood vessels can help identify underlying cardiovascular disease and assist in choices for further investigation and appropriate treatments. We hope that better cardiovascular monitoring will have significant benefits patients and the health system.

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