Related Experiment Video
Updated: Jul 3, 2026
14:09
Tilt Testing with Combined Lower Body Negative Pressure: a "Gold Standard" for Measuring Orthostatic Tolerance
Published on: March 21, 2013
Head-up tilt testing with different nitroglycerin dosages: experience in elderly patients with unexplained syncope
Ana Teresa Timoteo1, Mario Martins Oliveira, Joana Feliciano
1Cardiology Department, Santa Marta Hospital, R. Santa Marta, 1169-024 Lisboa, Portugal. ana_timoteo@yahoo.com
Summary
In elderly patients with unexplained syncope, sublingual nitroglycerin (NTG) dosage during head-up tilt testing (HUT) did not affect positive test rates or exaggerated nitrate responses. The NTG dose is not a determining factor in HUT outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Sublingual nitrates are increasingly used to enhance head-up tilt testing (HUT) diagnostic accuracy.
- Elderly patients frequently exhibit exaggerated responses to nitrates during HUT.
Purpose of the Study:
- To investigate if the provocative effect of sublingual nitroglycerin (NTG) is dose-dependent in elderly individuals experiencing unexplained syncope.
Main Methods:
- 120 elderly patients with syncope underwent HUT with sublingual NTG (500, 375, or 250 microg).
- Tests were analyzed for positive responses (symptoms with bradycardia/hypotension) and exaggerated nitrate responses (gradual blood pressure decrease).
Main Results:
- No significant differences in clinical characteristics were observed between dosage groups.
- A positive HUT test occurred in 50% of patients across all NTG dosage groups.
- The incidence of exaggerated nitrate responses was consistent (15-17%) regardless of NTG dose.
Conclusions:
- Sublingual NTG's impact on HUT results, including positive test rates and exaggerated responses, is not dose-dependent in the elderly population.
- Different NTG dosages do not alter the likelihood of exaggerated responses in elderly patients undergoing HUT for syncope evaluation.
Related Concept Videos
01:16Antianginal Drugs: Nitrates and β-Blockers
In cardiovascular health, antianginal drugs combat angina pectoris — a condition marked by chest pain owing to diminished blood flow to the heart.
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
Organic nitrates, such as nitroglycerin, play a pivotal role. Once metabolized, they liberate nitric oxide, a molecular marvel. Nitric oxide triggers guanylyl cyclase and augments cGMP production. This biochemical cascade orchestrates the relaxation of vascular smooth muscles, ushering in vasodilation and enhancing coronary blood flow. Administered...
01:20Angina V: Nursing Management
Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
01:15Drug Dosing: Geriatric Patients
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
01:29Angina III: Clinical Manifestations and Assessment
Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
01:28Special considerations while measuring blood pressure
When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...