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Head-up Tilt Table Testing: a state-of-the-art review.

M P Tan1, G W Duncan, S W Parry

  • 1Institute for Ageing and Health, Newcastle University, Newcastle, UK.

Minerva Medica
|September 15, 2009
PubMed
Summary
This summary is machine-generated.

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Vasovagal syncope (VVS), a common cause of fainting, is increasingly diagnosed in the elderly using the head-up tilt-table test (HUTT). HUTT reveals sympathetic withdrawal as a key factor in VVS, improving diagnostic accuracy.

Area of Science:

  • Cardiology
  • Neurology
  • Physiology

Background:

  • Vasovagal syncope (VVS) is the most frequent cause of syncope, accounting for up to 60% of cases.
  • The head-up tilt-table test (HUTT), introduced in 1986, is a widely used diagnostic tool for VVS.
  • VVS is now diagnosed more frequently in the elderly, challenging previous assumptions about its prevalence in younger populations.

Purpose of the Study:

  • To explore the diagnostic utility and evolving understanding of Vasovagal Syncope (VVS) through the Head-Up Tilt-Table Test (HUTT).
  • To investigate the pathophysiological mechanisms underlying VVS, particularly the role of sympathetic withdrawal.
  • To discuss the practical aspects and limitations of conducting HUTTs in clinical settings.

Main Methods:

  • Utilizing the head-up tilt-table test (HUTT) as a primary diagnostic and research tool for Vasovagal Syncope (VVS).

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  • Employing provocation agents like glyceryl trinitrate during HUTT to enhance diagnostic yield.
  • Analyzing physiological changes during HUTT to understand VVS pathophysiology.

    • Main Results:

    • The head-up tilt-table test (HUTT) has increased the diagnosis of Vasovagal Syncope (VVS) in the elderly.
    • Research indicates that the hypotensive response in VVS is linked to sympathetic withdrawal, not solely bradycardia.
    • Provocation agents and specific patient presentations influence HUTT's diagnostic effectiveness.

    Conclusions:

    • The head-up tilt-table test (HUTT) is crucial for diagnosing Vasovagal Syncope (VVS) in cases with atypical features, seizure activity, or occupational concerns, especially in older patients.
    • History alone is often sufficient for diagnosing typical VVS presentations with infrequent episodes.
    • Understanding HUTT's practicalities and limitations is essential for accurate VVS diagnosis and management.