Methodology of Head-Up Tilt Test: What is the Sensitivity and Specificity of the Different Protocols?

  • A. Raviele
  • S. Themistoclakis
  • G. Gasparini
Conference paper


Transient hypotension and bradycardia of vasovagal origin are thought to be the most common cause of syncope (1). Substantiation of the diagnosis, however, is sometimes difficult when it is based solely on clinical history because of the possible absence of typical precipitating factors and prodromal symptoms, especially in older patients (2). A passive head-up tilt (HUT) for an extended time has proven to be a sufficiently strong gravitational stress to reproduce a vasovagal reaction in susceptible patients (3, 4). Thus, in recent years some investigators have proposed its use as a means of diagnosing vasovagal syncope in patients with otherwise unexplained loss of consciousness (5, 6). In normal individuals, assumption of passive upright posture produces a reduction in venous return and cardiac output with an immediate decrease in arterial pressure that is compensated for by a reflex arterial vasoconstriction and concomitant tachycardia essentially mediated by arterial baroreceptors (7). In patients prone to vasovagal reaction, instead of these compensatory adjustments, an abnormal reflex may develop which leads to paradoxical arterial vasodilatation and bradycardia with profound hypotension and syncope (8).


Tilt Test Vasovagal Syncope Unexplained Syncope Vasovagal Reaction Isoproterenol Infusion 
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Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • A. Raviele
    • 1
  • S. Themistoclakis
    • 1
  • G. Gasparini
    • 1
  1. 1.Divisione di CardiologiaOspedale Umberto IMestre-VeniceItaly

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