<b>Tilt Table Testing:</b> Concepts and Limitations

Grubb, Blair P.; Kosinski, Daniel

doi:10.1111/j.1540-8159.1997.tb03904.x

Cited by 123 publications

(74 citation statements)

References 25 publications

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“…Various posture tests are classically used to assess haemodynamic orthostatic adaptation and autonomic function. The most popular posture test used in clinical research is the passive head-up tilt table test at 70° (Grubb & Kosinski, 1997;Madden et al, 2008). Another active manoeuvre, the so-called squatting test, produces the strongest acute orthostatic stress when the subject stands up (Scheen et al, 1990; Marfella et al, 1994a).…”

Section: Non-invasive Continuous Monitoring Of Systolic and Diastolicmentioning

confidence: 99%

Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

Philips

Scheen

2011

Autonomic Neuroscience

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word count = 225 words SUMMARYThe squatting test is an active posture manoeuvre that imposes one of the most potent orthostatic stresses. In normal subjects, the changes in blood pressure and heart rate are transient because of appropriate baroreflex homeostasis and do not provoke symptoms.However, in various pathological conditions, both the increase in blood pressure during squatting and the decrease in blood pressure during standing may be more important and sustained, potentially leading to complaints and adverse events. Squatting has been used to evaluate patients with tetralogy of Fallot, heart transplant, dysautonomia, including diabetic cardiovascular autonomic neuropathy, and individuals prone to vasovagal syncope. Careful analysis of changes in blood pressure and heart rate during the transition from standing to squatting and from squatting to standing allows the early detection of altered vagal and/or sympathetic function. Of note squatting position has been proposed as a therapeutic mean to counteract the fall in blood pressure in patients suffering from dizziness due to dysautonomia and orthostatic hypotension or presenting pre-syncope symptoms, such as soon after exercise.The aims of the present review are to analyse the haemodynamic pattern during a squatting test in various pathological situations and to describe what may be the negative and positive haemodynamic changes associated with this posture. We were especially interested in using the squatting test for the assessment of cardiovascular autonomic neuropathy associated with diabetes mellitus.

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Section: Non-invasive Continuous Monitoring Of Systolic and Diastolicmentioning

confidence: 99%

Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

Philips

Scheen

2011

Autonomic Neuroscience

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“…15 HUT may help diagnose NCS since prolonged upright posture can cause venous pooling and provoke an autonomic reflex in predisposed individuals. 16,17 The patient is typically tilted upright at an angle of 70°-80° for 20-30 minutes. Isoproterenol may be infused after drugfree HUT, but this may reduce specificity in a dose-related manner.…”

Section: Workup For Syncopementioning

confidence: 99%

Evaluation and Management of Syncope

Bindra

Marchlinski

Lin

2008

Clinical medicine. Circulatory, respiratory and pulmonary medic

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Context Syncope is a commonly encountered by primary care physicians and cardiologists. Etiology is frequently not apparent, and patients may undergo unnecessary tests. Treatment must be tailored to the likely etiology. Complexities of diagnosis and treatment often warrant referral to a specialist. Objective To highlight the evolving recommendations for managing syncope in a clinically and cost effective manner. Evidence Acquisition An electronic literature search was undertaken of the Medline database from January 1996 to April 2006, using the Medical Subject Heading syncope, defibrillators, pacemakers, echocardiogram, cardiomyopathy, long QT syndrome, Arrhythmogenic right ventricular dysplasia, and Brugada syndrome. Abstracts and titles were reviewed to identify English-language trials. Bibliographies from the references as well as scientific statements from the Heart Rhythm Society, American Heart Association, and American College of Cardiology were reviewed. Evidence Synthesis A methodical approach to syncope can improve diagnosis, limit testing, and identify patients at risk of fatal outcome. A thorough history, physical exam and electrocardiogram are critical to the initial diagnosis. Presence of heart disease determines the extent of work-up and treatment. A trans-thoracic echocardiogram should be performed in patients with an unclear diagnosis and a positive cardiac history or an abnormal ECG. Ventricular arrhythmias are the most common cause of syncope in patients with structural heart disease. Patients with an ejection fraction less than 30 percent should receive an implantable defibrillator with few exceptions. An electrophysiology study may assist risk stratification in syncopal patients with borderline ventricular function. In patients without structural heart disease, the presence of a well defined arrhythmia syndrome consistent with a genetically determined risk of sudden death must be sought. The 12-lead electrocardiogram, family history and clinical presentation will identify most high-risk patients. Patients without structural heart disease can often be managed conservatively with well defined strategies for preventing neurocardiogenic syncope. Conclusions Managing syncope requires a methodical approach. An understanding of the limitations of the diagnostic tools and treatments is important. Lethal causes of syncope make it imperative to recognize the appropriate timing of referring patients to specialists.

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“…Mayores detalles acerca de esta metodología ha sido descrita en publicaciones previas [35,36]. Otras pruebas de evaluación autonómica están también disponibles y tiene gran utilidad en pacientes seleccionados [36,38,39 ].…”

Section: Evaluación De Pacientesunclassified

Síndromes de disfunción autonómica asociados con intolerancia ortostática.

Grubb¹,

Vesga²,

Guzmán³

et al. 2003

biomedica

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Los síndromes de disfunción autonómica asociados con la intolerancia ortostática son una de las alteraciones cuya fisiopatología fue reconocida hace sólo pocos años, lo que ha llevado a un mejor reconocimiento clínico. Entre las manifestaciones clínicas, el síncope y el presíncope asociados con ortostatismo son muy frecuentes. El espectro de la presentación clínica de estos síndromes varía desde la fatiga crónica hasta el síncope neurocardiogénico recurrente. En este artículo se revisa la fisiopatología y clasificación actual de los síndromes de disfunción autonómica asociados a intolerancia ortostática, así como las causas de disautonomía primaria y secundaria, y su enfoque diagnóstico y terapéutico.Palabras clave: intolerancia ortostática, disfunción autonómica, función autonómica, síncope mediado neuralmente, síncope vasovagal. Recent advances in diagnosis of autonomic disfunction syndromes associated with orthostatic intoleranceIn recent years increased interest has focused on the nature and pathophysiology of orthostatic intolerance and syndromes associated with autonomic disorders. Understanding the pathophysiology underlying these syndromes has led to the recognition of several distinct clinical entities with overlapping features and the associated need to reclassify many of the previously unrecognized syndromes. Among the clinical manifestations, syncope and near syncope are frequently associated with orthostatic intolerance. In addition, however, a wide spectrum of symptoms have been described ranging from chronic fatigue to recurrent neurally mediated vasodepressor reactions. The present review focuses on the pathophysiology and classification of syndromes of autonomic dysfunction associated with orthostatic intolerance. Primary and secondary causes of dysautonomia as well as therapeutic approach to these frequently unrecognized syndromes is presented.Key words: orthostatic intolerance, autonomic failure, autonomic function, neurally mediated syncope, vasovagal syncope. El sistema nervioso autónomo (SNA) como eje central del control cardiovascular modula los reflejos relacionados con el control de la presión arterial y la frecuencia cardíaca, lo que permite mantener un gasto cardíaco adecuado en respuesta al ortostatismo. El estudio fisiopatológico y la caracterización clínica de los síndromes de disfunción autonómica que se manifiestan con intoleracia ortostática han sido un reto para los investigadores de las áreas básicas y clínicas debido a su frecuente presentación y a la falta de herramientas terapéuticas que permitan su adecuado manejo.

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Tilt Table Testing: Concepts and Limitations

Cited by 123 publications

References 25 publications

Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

Squatting test: A posture to study and counteract cardiovascular abnormalities associated with autonomic dysfunction

Evaluation and Management of Syncope

Síndromes de disfunción autonómica asociados con intolerancia ortostática.

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