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Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents.
Pediatr Cardiol. 2003 May-Jun; 24(3):270-3.PC

Abstract

Vasovagal syncope is the most likely cause of syncope in the young. Head-up tilt-table test (HUT) provides the ability to provoke vasovagal syncope under controlled laboratory settings. In adult populations, pharmacologic stimulation with intravenous/sublingual isosorbide dinitrate (ISDN) has been shown to be an alternative to isoproterenol for increasing the diagnostic yield of HUT. In this study, 40 patients aged 9-18 years with unexplained syncope and 12 healthy age-matched children were evaluated by HUT to 70 degrees for 45 minutes. If tilting alone did not induce symptoms (syncope and presyncope), 0.1 mg/kg ISDN was given while the patient lay supine. After 5 min, the table was tilted to 70 degrees for 15 min or until the symptoms occurred. The control group consisted of 12 healthy age-matched children studied in a similar manner. Six patients (15%) had a positive basal tilt test. Twenty-five patients (62.5%) lost consciousness following ISDN administration. In the control group, nobody had a syncopal episode during the basal tilt test. However, ISDN administration resulted in 1 positive response (8.3%). The sensitivity of the test was 77.5% and its specificity was 91.6%. It is concluded that sublingual nitroglycerin HUT is suitable for routine clinical practice in children and adolescents with unexplained syncope.

Authors+Show Affiliations

Dindar A
Department of Pediatric Cardiology, Istanbul Faculty of Medicine, University of Istanbul, Millet Cd. Capa, 34390 Istanbul, Turkey.
Cetin B
No affiliation info available
Ertuğrul T
No affiliation info available
Cantez T
No affiliation info available

MeSH

Administration, SublingualAdolescentChildFemaleHumansHypotension, OrthostaticIsosorbide DinitrateMalePostureSensitivity and SpecificitySyncope, VasovagalTilt-Table TestVasodilator Agents

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12632227

Citation

Dindar, A, et al. "Sublingual Isosorbide Dinitrate-stimulated Tilt Test for Diagnosis of Vasovagal Syncope in Children and Adolescents." Pediatric Cardiology, vol. 24, no. 3, 2003, pp. 270-3.
Dindar A, Cetin B, Ertuğrul T, et al. Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents. Pediatr Cardiol. 2003;24(3):270-3.
Dindar, A., Cetin, B., Ertuğrul, T., & Cantez, T. (2003). Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents. Pediatric Cardiology, 24(3), 270-3.
Dindar A, et al. Sublingual Isosorbide Dinitrate-stimulated Tilt Test for Diagnosis of Vasovagal Syncope in Children and Adolescents. Pediatr Cardiol. 2003 May-Jun;24(3):270-3. PubMed PMID: 12632227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents. AU - Dindar,A, AU - Cetin,B, AU - Ertuğrul,T, AU - Cantez,T, Y1 - 2003/03/14/ PY - 2003/3/13/pubmed PY - 2003/11/13/medline PY - 2003/3/13/entrez SP - 270 EP - 3 JF - Pediatric cardiology JO - Pediatr Cardiol VL - 24 IS - 3 N2 - Vasovagal syncope is the most likely cause of syncope in the young. Head-up tilt-table test (HUT) provides the ability to provoke vasovagal syncope under controlled laboratory settings. In adult populations, pharmacologic stimulation with intravenous/sublingual isosorbide dinitrate (ISDN) has been shown to be an alternative to isoproterenol for increasing the diagnostic yield of HUT. In this study, 40 patients aged 9-18 years with unexplained syncope and 12 healthy age-matched children were evaluated by HUT to 70 degrees for 45 minutes. If tilting alone did not induce symptoms (syncope and presyncope), 0.1 mg/kg ISDN was given while the patient lay supine. After 5 min, the table was tilted to 70 degrees for 15 min or until the symptoms occurred. The control group consisted of 12 healthy age-matched children studied in a similar manner. Six patients (15%) had a positive basal tilt test. Twenty-five patients (62.5%) lost consciousness following ISDN administration. In the control group, nobody had a syncopal episode during the basal tilt test. However, ISDN administration resulted in 1 positive response (8.3%). The sensitivity of the test was 77.5% and its specificity was 91.6%. It is concluded that sublingual nitroglycerin HUT is suitable for routine clinical practice in children and adolescents with unexplained syncope. SN - 0172-0643 UR - https://www.unboundmedicine.com/medline/citation/12632227/Sublingual_isosorbide_dinitrate_stimulated_tilt_test_for_diagnosis_of_vasovagal_syncope_in_children_and_adolescents_ DB - PRIME DP - Unbound Medicine ER -