Short pain-provoked head-up tilt test for the confirmation of vasovagal syncope

Abstract

We investigated a short pain-provoked head-up tilt (PP-HUT) and the Calgary Syncope Symptom Score in a group of patients with clinically diagnosed vasovagal syncope and group of neurological patients without transient loss of consciousness. We included 127 consecutive patients who were investigated in our laboratory. The group 1 included 56 patients who after appropriate investigations were diagnosed with vasovagal syncope. The group 2 included 70 neurological patients without transient loss of consciousness. The subjects were tilted to 70° for a maximum period of 10 min or until symptoms occurred. If there were no symptoms after initial 10 min, a painful stimulus with the insertion of 0.7 mm needle into the dorsum of hand subcutaneously for 30 s was performed with the patient in the tilted for further 5 min. Calgary Syncope Symptom Score was calculated for all patients. In the group 1, significantly higher number of patients had positive results on PP-HUT (36 vs. 6 patients, respectively; p < 0,001). There was no difference in the presence of orthostatic hypotension (8 vs. 15 patients, respectively; p = 0.36) or postural orthostatic tachycardia syndrome (3 vs. 1 patient, respectively; p = 0.32) between groups. PP-HUT had sensitivity of 65.9 % (95 % CI 0.49-0.79) and specificity of 89.7 % (95 % CI 0.75-0.97). The CSSS had sensitivity of 58.5 % (95 % CI 0.42-0.73) and specificity of 46.1 % (95 % CI 0.30-0.63). PP-HUT has a higher diagnostic rate than the CSSS and provides a rapid alternative to conventional methods.

Assessment of prevalence and pathological response to orthostatic provocation in patients with multiple sclerosis

“…All patients diagnosed with RRMS who signed informed consent had a head-up tilt table test (HUTT) performed on them according to the standard protocol before application of corticosteroid therapy [9]. HUTT is conducted in two phases.…”

Venepuncture during head‐up tilt testing in patients with suspected vasovagal syncope – implications for the test protocol

“…Adamec et al . used a painful stimulus (insertion of a needle into the subcutis of the dorsum of the hand for 30 s) after 10 min of HUT to evoke VVS. They reported a sensitivity of 65.9%, but did not discriminate between patients with a positive or negative history for VP induced VVS.…”

Postural orthostatic tachycardia syndrome associated with multiple sclerosis

“…The PP-HUTT was performed as previously described (Adamec et al 2012). Patients were divided into two groups.…”