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A “Dysautonomic” Head‐Up Tilt Test Pattern in Elderly Patients with Neurocardiogenic Syncope
Author(s) -
BECK LIONEL,
PONS MAXIME,
PIOT CHRISTOPHE,
LECLERCQ FLORENCE,
MESSNERPELLENC PATRICK,
FERRIÈRE MARC,
DAVY JEANMARC
Publication year - 1999
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.1540-8159.1999.tb00564.x
Subject(s) - medicine , orthostatic vital signs , asymptomatic , syncope (phonology) , hemodynamics , blood pressure , heart rate , cardiology , population , vasovagal syncope , anesthesia , tilt table test , environmental health
The characteristics of neurocardiogenic syncope (NCS) in elderly patients remain unclear. We compared the hemodynamic profiles of young and older patients with consecutive and positive head‐up tilt tests (HUT). Continuous, noninvasive, and reliable monitoring of arterial pressure (AP) and heart rate (HR) was done throughout 46 consecutive positive HUTs of symptomatic patients. The population (12–82 years old) was divided into two groups: younger patients, Y (n = 25, ≤ 65 years), and older patients, O (n = 21). Changes in AP and HR after the first minute of tilting, during the stable orthostatic phase and during syncope were compared. Except for systolic pressure, baseline hemodynamic parameters were similar in Y and O. No difference appeared in the mean time elapsed before syncope (19 ± 9 vs 22 ± 2 min). Asymptomatic hypotension was observed, only in O, 1 minute after tilting, followed by a progressive fall in the mean AP before syncope (0 ± 0.9 vs −1 ± 0.7 mmHg/min) without HR increase (0.7 ± 1 vs 0 ± 0.6 beats/min). This pressure slope was strongly related to age (r = 0.54, P < 0.001). Hemodynamic recording during HUT identifies a dysautonomic pattern in elderly patients with NCS and the abnormal AP/HR responses to orthostasis may be a feature specific to this population. Although the central mechanism of NCS is common to all ages, the age‐related characteristics of the trigger event may indicate the need for specific management at different ages.