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Recurrent Unexplained Syncope in the Elderly: The Use of Head‐Upright Tilt Table Testing in Evaluation and Management
Author(s) -
Grubb Blair P.,
Wolfe Douglas,
Samoil Daniela,
Madu Ernest,
TemesyArmos Peter,
Hahn Harry,
Elliott Laura
Publication year - 1992
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1992.tb01801.x
Subject(s) - medicine , syncope (phonology) , tilt table test , tilt (camera) , pediatrics , physical medicine and rehabilitation , intensive care medicine , cardiology , blood pressure , heart rate , mechanical engineering , engineering
Objective To investigate the usefulness of head‐upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope. Design Prospective survey. Setting Electrophysiology laboratory of a university hospital. Patients Twenty‐five patients (11 male, 14 female; mean age 73 ± 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 ± 4 years). Methods Each patient underwent head‐upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1–3 μg/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both. Main Results Syncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow‐up period of 24 months, no further syncopal episodes have occurred. Conclusions Head‐upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.