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[Syncope of undetermined nature after electrophysiologic study. Usefulness of the head-up tilt test in the diagnosis of vaso-vagal origin and in the choice of treatment].
G Ital Cardiol. 1990 Mar; 20(3):185-94.GI

Abstract

The vaso-vagal nature of syncopes which remained unexplained despite full clinical and electrophysiological investigation was evaluated by means of 60 degrees head-up tilt test for 60 minutes. Thirty patients (16 men and 14 women, mean age 63.6 years, 19 with and 11 without organic heart disease) with 1 to 28 (mean 5.1) episodes of syncope of unknown origin were studied together with 11 asymptomatic control subjects. Head-up tilt test was considered positive if syncope developed in association with hypotension and/or bradycardia. During baseline head-up tilt 15 patients (50%) showed a positive test, with vasodepressor response (marked hypotension without marked bradycardia) in 10 cases and with mixed response (marked hypotension with marked bradycardia) in 5 cases. None of the control subjects became symptomatic during the test. Mean time to syncope was 24.9 minutes. Baseline head-up tilt test was reproducibly positive in 10 out of 14 patients (71%). Eight of these 10 patients underwent serial head-up tilt tests after atropine (0.04 mg/Kg i.v. in 1 minute), propranolol (0.2 mg/Kg i.v. in 3 minutes) and etilefrin (15-30 mg/day orally for 2-3 days) to determine the pathogenesis of vaso-vagal syncope. Atropine prevented tilt-induced syncope in 3 out of 7 patients (43%), propranolol in 2 out of 7 (29%) and etilephrine in 6 out of 6 (100%). Seven patients were chronically treated with drugs selected on the basis of acute drug testing. One patient-responder to atropine received transdermal scopolamine and the other 6 received etilephrine. None of these 7 patients had syncopal recurrences or death during a mean follow-up of 7.7 months, except 1 who experienced another episode of syncope after having discontinued etilephrine 4 months before. These results suggest that: 1) head-up tilt is a very sensitive and highly specific test to unmask susceptibility to vaso-vagal reaction in patients with syncope of unknown origin; 2) withdrawal of alpha-sympathetic stimulation is the principal mechanism responsible for vasodilation and syncope during head-up tilt; 3) alpha-sympathomimetic agents, such as etilephrine, are effective in preventing spontaneous episodes of vaso-vagal syncope during a short-term follow-up.

Authors+Show Affiliations

Raviele A
Divisione Cardiologica, Ospedale Umberto I, Mestre, Venezia.
Gasparini G
No affiliation info available
Di Pede F
No affiliation info available
Delise P
No affiliation info available
Bonso A
No affiliation info available
Piccolo E
No affiliation info available

MeSH

AdolescentAdultAgedAged, 80 and overAtropineBradycardiaElectrophysiologyEtilefrineEvaluation Studies as TopicFemaleFollow-Up StudiesHumansHypotensionMaleMiddle AgedPosturePropranololSyncope

Pub Type(s)

English Abstract
Journal Article
Review

Language

ita

PubMed ID

1971602

Citation

Raviele, A, et al. "[Syncope of Undetermined Nature After Electrophysiologic Study. Usefulness of the Head-up Tilt Test in the Diagnosis of Vaso-vagal Origin and in the Choice of Treatment]." Giornale Italiano Di Cardiologia, vol. 20, no. 3, 1990, pp. 185-94.
Raviele A, Gasparini G, Di Pede F, et al. [Syncope of undetermined nature after electrophysiologic study. Usefulness of the head-up tilt test in the diagnosis of vaso-vagal origin and in the choice of treatment]. G Ital Cardiol. 1990;20(3):185-94.
Raviele, A., Gasparini, G., Di Pede, F., Delise, P., Bonso, A., & Piccolo, E. (1990). [Syncope of undetermined nature after electrophysiologic study. Usefulness of the head-up tilt test in the diagnosis of vaso-vagal origin and in the choice of treatment]. Giornale Italiano Di Cardiologia, 20(3), 185-94.
Raviele A, et al. [Syncope of Undetermined Nature After Electrophysiologic Study. Usefulness of the Head-up Tilt Test in the Diagnosis of Vaso-vagal Origin and in the Choice of Treatment]. G Ital Cardiol. 1990;20(3):185-94. PubMed PMID: 1971602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Syncope of undetermined nature after electrophysiologic study. Usefulness of the head-up tilt test in the diagnosis of vaso-vagal origin and in the choice of treatment]. AU - Raviele,A, AU - Gasparini,G, AU - Di Pede,F, AU - Delise,P, AU - Bonso,A, AU - Piccolo,E, PY - 1990/3/1/pubmed PY - 1990/3/1/medline PY - 1990/3/1/entrez SP - 185 EP - 94 JF - Giornale italiano di cardiologia JO - G Ital Cardiol VL - 20 IS - 3 N2 - The vaso-vagal nature of syncopes which remained unexplained despite full clinical and electrophysiological investigation was evaluated by means of 60 degrees head-up tilt test for 60 minutes. Thirty patients (16 men and 14 women, mean age 63.6 years, 19 with and 11 without organic heart disease) with 1 to 28 (mean 5.1) episodes of syncope of unknown origin were studied together with 11 asymptomatic control subjects. Head-up tilt test was considered positive if syncope developed in association with hypotension and/or bradycardia. During baseline head-up tilt 15 patients (50%) showed a positive test, with vasodepressor response (marked hypotension without marked bradycardia) in 10 cases and with mixed response (marked hypotension with marked bradycardia) in 5 cases. None of the control subjects became symptomatic during the test. Mean time to syncope was 24.9 minutes. Baseline head-up tilt test was reproducibly positive in 10 out of 14 patients (71%). Eight of these 10 patients underwent serial head-up tilt tests after atropine (0.04 mg/Kg i.v. in 1 minute), propranolol (0.2 mg/Kg i.v. in 3 minutes) and etilefrin (15-30 mg/day orally for 2-3 days) to determine the pathogenesis of vaso-vagal syncope. Atropine prevented tilt-induced syncope in 3 out of 7 patients (43%), propranolol in 2 out of 7 (29%) and etilephrine in 6 out of 6 (100%). Seven patients were chronically treated with drugs selected on the basis of acute drug testing. One patient-responder to atropine received transdermal scopolamine and the other 6 received etilephrine. None of these 7 patients had syncopal recurrences or death during a mean follow-up of 7.7 months, except 1 who experienced another episode of syncope after having discontinued etilephrine 4 months before. These results suggest that: 1) head-up tilt is a very sensitive and highly specific test to unmask susceptibility to vaso-vagal reaction in patients with syncope of unknown origin; 2) withdrawal of alpha-sympathetic stimulation is the principal mechanism responsible for vasodilation and syncope during head-up tilt; 3) alpha-sympathomimetic agents, such as etilephrine, are effective in preventing spontaneous episodes of vaso-vagal syncope during a short-term follow-up. SN - 0046-5968 UR - https://www.unboundmedicine.com/medline/citation/1971602/[Syncope_of_undetermined_nature_after_electrophysiologic_study__Usefulness_of_the_head_up_tilt_test_in_the_diagnosis_of_vaso_vagal_origin_and_in_the_choice_of_treatment]_ DB - PRIME DP - Unbound Medicine ER -