Utility of upright tilt-table testing in the evaluation and management of syncope of unknown origin

Grubb, Blair P.; Temesy‐Armos, Peter; Hahn, Harry; Elliott, Laura

doi:10.1016/0002-9343(91)90499-n

Cited by 214 publications

(58 citation statements)

References 9 publications

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“…Some HUT protocols using isoproterenol show a positive rate of 75% to 87%. 6,16,17) The rate of positive response increased to 94% with the addition of isoproterenol in the tilt test in the present study. However, the addition of isoproterenol in the tilt test may entail a risk of inducing coronary artery spasm in some participants.…”

Section: Discussionsupporting

confidence: 56%

“…Some studies reporting the time to the development of a positive response found the average time was 30 minutes for a 60-degree tilt and 10 minutes for an 80-degree tilt. [7][8][9]13,14,16,19) Our data showed that the average time to the development of a positive response was 4.3 ± 2.9 min for an 80-degree tilt in 73 patients. The pathophysiologic mechanism of N-M syncope is not fully understood.…”

Section: Discussionmentioning

confidence: 58%

“…9,10) A review of recently published data evaluating beta-blockers for the treatment of N-M syncope has shown oral beta-blockers to be effective in 72% of patients with N-M syncope as tested by the repeat HUT test. 16,[19][20][21] Our data showed that the efficacy of Atenolol in the prevention of inducible syncope or pre-syncope is 46% (16 / 35). In addition, our data showed that the mean dosage of isoproterenol needed to provoke a positive HUT test in 19 patients who had received Atenolol and had a positive repeat HUT test was higher after Atenolol therapy than at baseline (3.5 ± 0.9 µg / min, after Atenolol therapy vs 2.3 ± 1.2 µg / min, baseline p < 0.001).…”

Section: Discussionmentioning

confidence: 62%

“…Some studies have observed that sympathetic activity increased markedly before the onset of hypotension and / or bradycardia during the passive HUT test. 16,17) Thus, the concept that the addition of isoproterenol infusion during the HUT test might help increase the sensitivity of the test emerged. In 1989 Almquist, et al .…”

Section: Discussionmentioning

confidence: 99%

“…Beta-blockers were commonly used in the prevention of recurrence of N-M syncope. 6,16) The mechanism of action of beta-blockers is not fully understood, but they may diminish cardiac contractility, inhibiting the activation of cardiac mechanoreceptors.…”

Section: Discussionmentioning

confidence: 99%

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<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Fang

Kuo

2000

Jpn Heart J

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SUMMARYThis study included 87 consecutive patients with unexplained syncope or pre-syncope who had undergone the head-up tilt (HUT) test with concomitant isoproterenol infusion. A positive response was defined as development of syncope or pre-syncope in association with substantial hypotension (decline of systolic blood pressure > 20 mmHg). Coronary artery spasm was suggested from the clinical symptoms and electrocardiographic findings in 1 patient (1 / 87 = 1.1%). Intolerance to isoproterenol infusion was noted in 8 cases (8 / 87 = 9%). Of the 78 patients who completed the study, 73 showed positive responses (73 / 78 = 94%). (baseline systolic blood pressure = 125 ± 23 mmHg vs endpoint systolic blood pressure = 76 ± 11 mmHg, p < 0.05; baseline heart rate = 73 ± 14 beats per minute vs endpoint HR = 80 ± 24 beats per minute, p < 0.05). In 73 patients who showed positive responses, the systolic blood pressure (SBP) and heart rate (HR) returned to a safe level at 2 minutes when the patients were returned to a supine position (post-study 2 minutes SBP = 124 ± 18 mmHg vs baseline SBP = 125 ± 23 mmHg, p = NS; post-study 2 minutes HR = 82 ± 18 beats per minute vs baseline HR = 73 ± 14 beats per minute, p < 0.05). All 73 patients with a positive HUT test received Atenolol therapy (50 mg daily). Only 35 of these 73 patients took Atenolol regularly and had a repeat HUT test. After atenolol therapy, persistent positive responses were observed in 19 cases (19 / 35 = 54%) and negative responses were noted in 16 cases (16 / 35 = 46%). The mean dosage of isoproterenol needed to provoke a positive HUT test in 19 patients who had received Atenolol therapy and had a positive repeat HUT test was 2.3 ± 1.2 µg / min at baseline and 3.5 ± 0.9 µg / min for post-Atenolol therapy (p < 0.001). Sixteen patients with a negative repeat HUT test were treated continuously with Atenolol and followed for a mean period of 13 ± 11 months (range, 1-34 months). All 16 patients were free of syncope or pre-syncope during the period of follow up. In conclusion, the HUT test is mostly well tolerated and safe, even though the test has a low rate of adverse effects. Atenolol is effective for the prevention of provoked or spontaneous recurrent syncope or pre-syncope. (Jpn Heart J 2000; 41: 623-631)

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Fang

Kuo

2000

Jpn Heart J

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Delayed Orthostatic Intolerance

Streeten

Anderson²

1992

Arch Intern Med

115

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In seven patients who presented with lightheadedness, fatigue, "weakness," and sometimes syncope, blood pressure was found not to fall after standing for 3 to 4 minutes but to fall severely, frequently with syncope or presyncopal symptoms, after 13 to 30 minutes when measured every minute with an automatic device. This delayed orthostatic hypotension could be corrected with inflation of a pressure suit to 45 mm Hg. Its mechanism was further investigated with measurements of plasma catecholamines, plasma cortisol and aldosterone responses to corticotropin, and the effects of norepinephrine infusions on blood pressure and venous contractility. There was normal or excessive orthostatic norepinephrine release in all patients, evidence of impaired venous innervation in the legs in some, and various disorders in the other patients. Since therapeutic improvement in the orthostatic hypotension greatly reduced the symptoms, we concluded that orthostatic hypotension occurring after more than 10 minutes of standing is a potentially debilitating and often correctable disorder.

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The Value of Tilt Table Testing With Isoproterenol in Determining Therapy in Adults With Syncope and Presyncope of Unexplained Origin

Tonnessen

Haft²,

Fulton³

et al. 1994

Arch Intern Med

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Utility of upright tilt-table testing in the evaluation and management of syncope of unknown origin

Cited by 214 publications

References 9 publications

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

<b>Usefulness of Head-up Tilt Test in the Evaluation and Management of Unexplained Syncope or Pre-syncope</b>

Delayed Orthostatic Intolerance

The Value of Tilt Table Testing With Isoproterenol in Determining Therapy in Adults With Syncope and Presyncope of Unexplained Origin

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