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Results for “Tilt-test”

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6 recordsLinked to original sources

PubMed1992

[Value and limits of the tilt-test in the etiological diagnosis of transient malaise].

This study was undertaken to assess the usefulness of the head-up tilt test in the diagnosis of vasovagal syncope and to evaluate the indications of this investigation. The test consists in a 30 minute period in the horizontal decubitus position followed by a 60 degrees head-up tilt position for 30 minutes. In the 26 subjects in whom the diagnosis of repeated vasovagal syncope had been made on the basis of typical prodromic symptoms after exclusion of all other causes, the test induced a vasodepressive or vagal reaction in 10 cases (38%) 20 +/- 4 minutes after tilting. In 8 patients in whom the test was performed within 48 hours of their syncopal episode, a similar malaise was induced in 7 cases. Twenty patients with repeated malaise without loss of consciousness had no symptoms during the test which was also negative in 10 normal control subjects. In a group of 27 subjects with unexplained syncope after clinical and paraclinical investigations, the test was accompanied by a malaise on five occasions (19%). Using this protocol, the tilt test had good specificity but moderate sensitivity in the diagnosis of vasovagal syncope. Its sensitivity increased when performed within 48 hours of syncope. It is of no value in the diagnosis of recurrent malaise without loss of consciousness.

Blood Pressure↗

PubMed1992

Evaluation of syncope by upright tilt testing with isoproterenol. A nonspecific test.

OBJECTIVE: To determine the proportion of patients with syncope of unknown etiology who have a positive response to upright tilt testing and to determine the specificity of this test as a marker for vasodepressor syncope. DESIGN: Comparison of upright tilt testing with isoproterenol in patients with syncope of unknown etiology and in controls. SETTING: Outpatient clinics of a tertiary care center. PATIENTS: A total of 20 patients with syncope of unknown etiology and 40 controls matched by age, sex, and lack of underlying cardiovascular or other diseases had upright tilt testing with isoproterenol infusion. Controls consisted of two groups (groups I and II) who had slightly different methods of tilt testing in conjunction with isoproterenol. INTERVENTIONS: Upright tilt testing at 80 degrees from horizontal was done for up to 15 minutes. If end points were not reached, infusion of isoproterenol was started at 1 microgram/min and increased with graded increments in infusion rates up to 5 micrograms/min. MEASUREMENTS: The development of syncope or presyncope in association with hypotension, bradycardia, or both. MAIN RESULTS: Positive response to tilt testing in patients with syncope was 75% (95% CI, 55% to 95%); it was 65% in control group I (CK, 44% to 86%) and 45% in control group II (CI, 20% to 70%). Case patients and controls with positive tilt-test responses were similar with respect to time to completion of the test, mean total isoproterenol dose, mean isoproterenol dose level at completion, average mean blood pressure at completion, mean heart rate at completion, mean decline in systolic blood pressure, and decline in mean blood pressure or heart rate (P greater than 0.05 for all comparisons). Further, symptoms during tilt testing in case patients with positive responses were similar to those in controls with positive tilt-test results. CONCLUSIONS: The rate of positive tilt testing in patients with syncope is equivalent to that in controls without a history of syncope. The low specificity of this test makes its use as a marker for vasodepressor syncope questionable.

Adolescent↗

PubMed1992

[Methods of investigating orthostatic hypotension].

Orthostatic hypotension, which is common mainly in the elderly, is in many cases related to hypovolemia and/or vasodilators intake. However, when an impairment of the autonomic nervous system is suspected, orthostatic hypotension severity and mechanism may be investigated. The most common tests are the head upright tilt-test and the Valsalva manoeuvre. Both of them examine the baroreflex system as a whole, and become non invasive tests with the development of finger arterial blood pressure continuous measurement. Each part of the baroreflex system may be investigated separately. So, cardiac vagal responses to ocular compression, to carotid sinus massage, to respiratory change or to atropine infusion, may be tested. On the other hand, sympathetic efferent pathways may be stimulated in a variety of ways, such as isometric exercise, cutaneous cold, mental arithmetic, norepinephrine infusion, or tiltest. None of these tests should be applied systematically, but according to the clinical features.

Aged↗

PubMed1992

[Natural history of syncope of undetermined origin with inconclusive electrophysiologic examination].

Between 1985 and 1986, 109 consecutive patients with unexplained syncope after clinical and standard electrocardiographic examination underwent electrophysiological investigation. In 61 cases (56%), 35 men and 26 women (mean age 69 +/- 13 years) no firm diagnosis could be made. These patients were the study group. Underlying cardiac disease was present in 23%, coronary artery disease in 10% of cases. In 33 cases, the basal ECG was normal (54%). Sixty patients (one lost to follow-up) were studied over an average of 38 +/- 12 months. Global mortality and recurrence rate were 13 and 18% respectively. There were no sudden deaths in the 8 fatalities. The mechanism of the 17 recurrent syncopes was cardiac in 5 cases, vasovagal in 1 case, uncertain in 11 cases. Of the 5 cardiac syncopes, 3 were related to 3rd degree atrioventricular block occurring 7 to 49 months after the initial electrophysiological investigation. No predictive criteria of recurrence could be identified. Empiric treatment proposed to 28% of patients did not prevent recurrent syncope and did not improve global survival. Inconclusive electrophysiological investigation of patients with unexplained syncope defines a population with a low risk of sudden death. Recurrent syncope is common. The recurrence of symptoms is an indication to repeat the aetiological investigations which should include a tilt-test ot another electrophysiological investigation. Empiric treatment has not been shown to be effective.

Actuarial Analysis↗

PubMed1977

[Stress hemodynamics in fresh myocardial infarct].

Hemodynamic measurements before and during graded leg-up tilt were performed in 20 patients on the 1st and 3rd day following myocardial infarction. In those with an elevated pulmonary capillary pressure (greater than 11 mm Hg), independent of the cardiac index, the tilt-test (i.e. an additional increase in preload) unmasked heart failure. When applied to test drug responses, furosemide (n = 7) reduced the tilt-stimulated cardiac index with an attendant fall in pulmonary capillary pressure; nitroglycerine (n = 7) did not change cardiac index but reduced the pulmonary capillary pressure.

Cardiac Output↗

PubMed2026

Electroencephalographic evidence of cortical network disruption preceding overt cardioinhibition during tilt-induced reflex syncope.

OBJECTIVE: Reflex syncope is a common cause of transient loss of consciousness. However, the early cerebral mechanisms underlying cardiovascular changes remain poorly understood. Our objective was to investigate early cerebral changes by quantitatively analyzing EEG activity preceding overt cardioinhibition during tilt-induced reflex syncope. METHODS: EEG recordings from patients undergoing tilt testing were retrospectively analyzed. Patients who experienced reflex syncope were compared to those who did not. Spectral and functional connectivity analyses were performed across baseline, pre-cardioinhibition, and syncopal phases. RESULTS: Prior to the onset of cardioinhibitory pathological reflex, a significant increase in theta-band spectral power was observed in the right temporal region, accompanied by a widespread increase in functional connectivity within the same frequency band. These findings suggest the involvement of brain networks before cardioinhibition. CONCLUSIONS: EEG changes in the theta band (power and functional connectivity) were observed before overt cardioinhibition during tilt-induced reflex syncope. SIGNIFICANCE: Our findings support the hypothesis of cortical processing preceding cardioinhibition in reflex syncope. EEG may represent a valuable complementary tool for improving the understanding and diagnosis of these events.

Humans↗