[Value of the head-up tilt test in the etiologic diagnosis of syncope]

The cause of brief syncopes is discovered in only two-thirds of the cases at most. The purpose of this study was to quantify the value of the head-up tilt test in patients whose syncope remained "causeless" after a "conventional" investigation. Forty-nine patients entered the study on the following criteria: at least one syncope, no conduction disturbances or normal electrophysiological study, physiological response to carotid sinus massage, absence of postural hypotension and assessable tilt test. The head-up tilt test was performed under blood pressure and electrocardiographic monitoring in three stages: dorsal decubitus during 20 min, 60 degrees tilting during 20 min and, if nothing happened, isoprenaline injection. The test was positive (i.e. produced syncope or at least lipothymia) in 12 patients (24.5 per cent). In all cases the loss of consciousness was associated with a deep fall in blood pressure, but prolonged ventricular pause never occurred (2 patients had bradycardia at about 30 beats/min). The head-up tilt test is a non-invasive examination which in one-quarter of the cases provides a diagnosis of vasovagal syncope when no other diagnosis could be made; it reproduces the syncope, which is rarely done by other investigations, and it deserves to be include in the evaluation of unexplained syncopes.