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Related Experiment Videos

Head-up tilt: a useful test for investigating unexplained syncope.

R A Kenny, A Ingram, J Bayliss

    Lancet (London, England)
    |June 14, 1986
    PubMed
    Summary

    Head-up tilt testing effectively diagnosed vasovagal syncope in older adults with unexplained fainting. This diagnostic tool identified syncope in 67% of patients, aiding in treatment decisions.

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    Area of Science:

    • Cardiology
    • Neurology
    • Geriatrics

    Background:

    • Unexplained syncope is a common and challenging clinical problem, particularly in older adults.
    • Standard clinical and electrophysiological assessments often fail to identify the cause of syncope.
    • Vasovagal syncope is a potential cause of syncope, but its diagnosis in the elderly can be difficult.

    Purpose of the Study:

    • To evaluate the utility of head-up tilt testing in diagnosing unexplained syncope in elderly patients.
    • To compare the response to head-up tilt testing in patients with unexplained syncope and healthy controls.
    • To assess the effectiveness of pacemaker implantation in patients with tilt-induced vasovagal syncope.

    Main Methods:

    • Fifteen patients (mean age 65 years) with unexplained syncope underwent 40-degree head-up tilt testing for 60 minutes.
    • Continuous monitoring of systolic blood pressure and heart rate was performed during the tilt test.
    • Ten age-matched control subjects without a history of syncope were also studied using the same protocol.

    Main Results:

    • Vasovagal syncope was induced in 10 out of 15 patients (67%) and one control subject.
    • During syncope, patients experienced a significant drop in systolic blood pressure (150 to 56 mm Hg) and heart rate (62 to 38 bpm).
    • Symptoms during the tilt test reproduced the patients' previous syncopal episodes, and no baseline clinical factors predicted syncope development.

    Conclusions:

    • Head-up tilt testing is a valuable diagnostic tool for unexplained syncope in older adults, revealing vasovagal syncope in a majority of cases.
    • Pacemaker implantation was successful in seven patients, leading to sustained symptom relief.
    • Further investigation into the role of autonomic dysfunction and pacing strategies in this population is warranted.

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