Intravenous Cannulation alters the Specificity of Head-up Tilt Testing for Vasovagal Syncope in Elderly Patients

McIntosh, S. J.; Lawson, John; Kenny, Rose Anne

doi:10.1093/ageing/23.4.317

Cited by 49 publications

(24 citation statements)

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“…Diagnostic head-up tilt test: No intravenous cannulation was performed in order to lessen the rate of false positive test results. 10,11) Resting phase in the recumbent position constituted a period of at least 5 minutes. At the end of the resting phase, the patients were tilted to a standard angle of 70 degrees for a period of 30 minutes.…”

Section: Methodsmentioning

confidence: 99%

Tilt Training for Recurrent Neurocardiogenic Syncope: Effectiveness, Patient Compliance, and Scheduling the Frequency of Training Sessions

et al. 2004

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SUMMARYUnsatisfactory results obtained with medical therapy and dual-chamber pacing for prevention of recurrent neurocardiogenic syncope necessitated the development of new treatment modalities. Tilt-training, a novel treatment for recurrent neurocardiogenic syncope based on exercise sessions with prolonged upright posture (either on a tilt-table or standing on foot against a wall), was shown to be effective in preventing the recurrence of neurocardiogenic syncope. The purpose of this study was to demonstrate the long-term beneficial effects of a transient tilt training program lasting 2 months.Thirty-two patients with recurrent neurocardiogenic syncope (mean number of syncope episodes in the last 6 months was 3.4 ± 2.3) constituted the study group. All of the patients were tilt test positive. The patients were taught a tilt training program with 2 phases (in-hospital training with repeated tilt procedures until 3 consecutive negative results were obtained and home exercises with standing against a wall) and home exercises lasted a maximum of 2 months. After this training program, the patients received no treatment and were followed for the recurrence of syncope. At the end of the follow-up period (376 ± 45 days), 81% of the patients were free of recurrent syncope.This study revealed that similar successful results can also be obtained with a transient tilt training program as a first line treatment strategy. Less interference with the daily activities of the patients is the major advantage of this strategy. The ease of performance and high effectiveness rate will most likely result in more frequent utilization of this treatment modality. (Jpn Heart J 2004; 45: 833-843) Key words: Recurrent neurocardiogenic syncope, Tilt training program RECURRENT neurocardiogenic syncope, which is defined as a sudden, transient loss of consciousness due to neurally-mediated hypotension and bradycarFrom the

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Section: Methodsmentioning

confidence: 99%

Tilt Training for Recurrent Neurocardiogenic Syncope: Effectiveness, Patient Compliance, and Scheduling the Frequency of Training Sessions

et al. 2004

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“…The patients should be in a supine position 20-45 min before tilting. This time interval was proposed to decrease the likelihood of a vasovagal reaction in response to venous cannulation [120,121] . With the protocols that do not use venous cannulation, time in the supine position before tilting can be reduced to 5 min.…”

Section: Tilt Test Protocolsmentioning

confidence: 99%

“…Continuous beat-to-beat finger arterial blood pressure should be monitored non-invasively [122] . Invasive measurements of arterial blood pressure can affect the specificity of the test, especially in the elderly [120] and in children [121] . Although intermittent measurement of pressure using a sphygmomanometer is less desirable, it is an accepted method of testing and is widely used in clinical practice, especially in children.…”

Section: Tilt Test Protocolsmentioning

confidence: 99%

Guidelines on management (diagnosis and treatment) of syncope

Brignole¹,

Alboni²,

Benditt

et al. 2001

European Heart Journal

677

432

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“…[11] The test was considered positive if the patient experienced syncope or presyncopal symptoms similar to the spontaneous episode of syncope ,if there was slowing of the heart rate at the onset of symptoms or there was a drop of systolic pressure to less than or equal to 90 mmHg or by more than 50 mmHg from peak, associated with symptoms. [12] …”

Section: Methodsmentioning

confidence: 99%

Diagnostic utility of the head-up tilt test in syncope and the related complications

Salwan¹,

Salwan²,

Wadhwa³

2017

Int. J. Adv. Res. Biol. Sci

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Background: Recurrent syncope is a distressing symptom in which the cause may remain undetermined. A definitive diagnosis may help the patients to lead a normal life and avoid the unnecessary risk to their lives. Objective: To evaluate the effectiveness and safety of Head up Tilt Test (HUTT) in patients with undiagnosed syncope and to detect and follow up any complications arising out of the procedure. Material and methods: The head up tilt table test was performed in department of cardiology. 72 patients with a history of syncope or presyncope underwent upright tilt table testing to exclude vasovagal syncope, with baseline tilt and if negative followed by progressively increasing doses of isoprenaline infusion. 70° tilt was used and continuous heart rate and non-invasive BP recordings were made every 2 minutes or earlier when symptomatic. Results: The mean age of the patients was 48±16 years. None of the patients had carotid sinus hypersensitivity. Forty-five patients (62.5%) were positive for syncope. Four (5.55 %) were positive during the baseline tilt and forty-one (56.9%) were positive with the use of isoprenaline during tilt. The majority of positive responses were mixed 23 (51.11%), 17(37.77%) were vasodepressor and 5(11.11%) were cardioinhibitory. The mean time to syncope was 31.84 ± 8.0 minutes. There was a mean drop of 55.65 mmHg in systolic blood pressure and 36.06 mmHg in diastolic blood pressure in the positive group (p = <0.001 for both).No statistical significance was observed as regards the age ,sex and type of response. No significant untoward incidents were noted except partial seizures in one patient. Conclusion:The head-up tilt test is a simple, non-invasive, relatively safe test which is useful in documenting objective measures of orthostatic hypotension that cannot be obtained in a clinical setting.

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Intravenous Cannulation alters the Specificity of Head-up Tilt Testing for Vasovagal Syncope in Elderly Patients

Cited by 49 publications

References 0 publications

Tilt Training for Recurrent Neurocardiogenic Syncope: Effectiveness, Patient Compliance, and Scheduling the Frequency of Training Sessions

Tilt Training for Recurrent Neurocardiogenic Syncope: Effectiveness, Patient Compliance, and Scheduling the Frequency of Training Sessions

Guidelines on management (diagnosis and treatment) of syncope

Diagnostic utility of the head-up tilt test in syncope and the related complications

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