Although we tend to "shotgun" when ordering labs in elderly patients with syncope, the literature actually indicates that we can be very selective in testing with this group, letting the history and PE determine whether any tests are indicated. The most recent literature supporting this concept demonstrated that even cardiac enzyme testing and head CTs in elderly syncope patients were helpful in only 0.5% of cases. The only test that should routinely be obtained is the ECG...a good history and PE should be sufficient to determine when any other tests are indicated.
[Mendu, et al. Yield of diagnostic tests in evaluating syncopal episodes in older patients. Arch Intern Med 2009]
