Premium
Vasovagal Syncope: Diagnostic Role of Head‐Up Tilt Test in Patients with Positive Ocular Compression Test
Author(s) -
JAEGER FREDRICK J.,
SCHNEIDER LORI,
MALONEY JAMES D.,
CRUSE ROBERT P.,
FOUADTARAZI FETNAT M.
Publication year - 1990
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1990.tb04017.x
Subject(s) - medicine , vasovagal syncope , asystole , tilt table test , anesthesia , blood pressure , syncope (phonology) , heart rate , cardiology
We investigated the relative merits of the ocular compression test and the head‐up tilt test to aid differentiation of syncope and seizures in young patients. Sixteen patients (10 males and 6 females) with a mean age of 14 ± 4.7 (SD) years (range 7–22 years) underwent graded head‐up till (15°, 30°, and 45° for 2 minutes each, then 60° for 20 minutes) following positive ocular compression testing defined as precipitation of asystole for at least 3 seconds (mean 5 seconds ± 2 seconds, range 3–12 seconds). Each patient presented with recurrent unexplained loss of consciousness (mean number of episodes 30 ± 45, mean duration of illness 52 ± 40 months), and seven patients were receiving anticonvulsant medications, three of these had normal EEGs. Eleven patients (69%) developed vasovagal syncope during head‐up tilt, reproducing their clinical episodes (systolic blood pressure decreased from 105 ± 10 mmHg to 84 ± 13 mmHg, diastolic blood pressure from 75 ± 9 to 22 ± 25 mmHg, and heart rate from 89 ± 13 beats/mm to 37 ± 20 beats/min). Asystole occurred in two patients during vasovagal syncope lasting 11 seconds in one and 16 seconds in the other, and, it was associated with myoclonic movements in both (convulsive syncope). Based on these findings, and given the perceived potential hazards of the ocular compression test, the head‐up tilt test may be a safer procedure that adds useful information to the diagnostic evaluation of these patients.