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Tilt table testing for syncope and collapse

  • Ritsuko Kohno
  • Wayne O. Adkisson
  • David G. Benditt
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Abstract

Head-up tilt (HUT) has long been used to examine heart rate and blood pressure adaptation to changes in position. During such studies, incidental observations noted that some test subjects experienced total or near-total transient loss of consciousness and that, in some cases, hypotension was associated with unexpected marked bradycardia compatible with a vasovagal syncope (VVS) reaction. The first report of HUT as a clinical tool to confirm a diagnosis of suspected VVS was published in 1966, and led to the concept of using HUT as a diagnostic tool for VVS. Subsequently, HUT testing, either drug-free or, if necessary, with pharmacological provocation (usually nitroglycerin) has proven to be a useful and safe modality for identifying susceptibility to VVS. In this regard, it is recognized that VVS is best diagnosed by careful history taking. Unfortunately, the history may be non-diagnostic; HUT may be helpful in such cases. However, the interpretation of HUT requires care and experience; in particular, the outcome must be consistent with the patient’s clinical presentation. The reproduction of patient symptoms may not only provide a diagnosis, but also offer some comfort to the patient and family in that the medical team has documented the basis of symptoms and are thereby positioned to address therapy.

Keywords

Heart rate Bradycardia Vasovagal Cardioinhibition Vasodepressor 

Die Kipptischuntersuchung bei Synkope und Kollaps

Zusammenfassung

Die Kipptischuntersuchung (KTU) wird seit Langem genutzt, um die Anpassung von Herzfrequenz und Blutdruck bei Lageänderungen zu prüfen. In entsprechenden Studien hat man beobachtet, dass manche Teilnehmer vollständig oder fast vollständig das Bewusstsein verloren und dass in manchen Fällen eine Hypotonie mit einer unerwartet ausgeprägten Bradykardie assoziiert war, passend zu einer vasovagalen Synkopen(VVS)-Reaktion. Der erste Bericht über die KTU als klinisches Instrument, mit dem sich die Diagnose einer vermuteten VVS sichern lässt, stammt aus dem Jahr 1966 und führte zu dem Plan, die KTU als diagnostisches Verfahren für die VVS zu nutzen. In der Folgezeit hat sich die KTU als hilfreiche und sichere Modalität zur Identifikation einer VVS-Neigung erwiesen – ohne medikamentöse Beeinflussung oder, wenn erforderlich, mit pharmakologischer Provokation (gewöhnlich mit Nitroglyzerin). In diesem Zusammenhang sei festgestellt, dass die VVS am besten auf Basis einer gründlichen Anamneseerhebung diagnostiziert wird. Allerdings führt die Anamnese nicht immer zur Diagnose; dann kann die KTU von Nutzen sein. Die Interpretation der KTU erfordert jedoch Sorgfalt und Erfahrung; nicht zuletzt muss das Ergebnis mit dem klinischen Bild des Patienten im Einklang stehen. Die gezielte Auslösung der Symptome führt nicht nur potenziell zu einer Diagnose, vielmehr kann sie beim Patienten und seinen Angehörigen auch für eine gewisse Beruhigung sorgen, weil nun der Ursprung der Symptome dokumentiert ist und die Therapie in Angriff genommen werden kann.

Schlüsselwörter

Herzfrequenz Bradykardie Vasovagal Kardioinhibitorische Wirkung Vasodepressorischer Faktor 

Notes

Acknowledgements

D.G. Benditt is supported in part by a grant from the Dr. Earl E Bakken family in support of heart–brain research.

Compliance with ethical guidelines

Conflict of interest

R. Kohno, W.O. Adkisson, and D.G. Benditt declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • Ritsuko Kohno
    • 1
  • Wayne O. Adkisson
    • 1
  • David G. Benditt
    • 1
  1. 1.Cardiac Arrhythmia Center, Cardiovascular DivisionUniversity of MinnesotaMinneapolisUSA

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