Tilt Table Testing for Assessing Syncope by mikeholy


									                     Tilt table testing for assessing syncope*

Patient history

- Female patient, 66 years old, who experienced syncope while sitting for the first time
- ECG: atrial fibrillation
- Medication: Enalapril 20 mg, Seroxat 20 mg


Head-up tilt testing was performed by means of the Task Force Monitor (CNSystems, Graz, Austria)

-   beat-to-beat blood pressure
-   6 channel ECG display
-   Impedance cardiography (SV, CO, TPR)
-   Autonomic control system (HRV, BPV, BRS)


The patient was positioned supine on the tilt table for 5 minutes and was then set upright to 70 degrees according to
the guidelines. 10 minutes after tilting the patient began to sweat, beat-to-beat blood pressure, heart rate and total
peripheral resistance started to decrease resulting in blood pressure levels of 52/31 mmHg and an asystolia of 16
seconds. No heart rate rise during tilting can be observed (chronotropic incompetence).
Carotid sinus massage was negative on both sides.

                                                                                    Illustration 1: Trend view of heart
                                                                                    rate, blood pressure, stroke volume,
                                                                                    cardiac output and total peripheral




                                                                                    Illustration 2, spectral analysis of
                                                                                    heart rate variability: Immediately
                                                                                    before the syncope an excessive
                                                                                    sympathetic activity can be observed
                                                                                    leading to a reactive increase in vagal
                                                                                    activity (high frequency band, red
                                                                                    circle) and cardioinhibition.
                                                                     tilt back

                                                              Head-up tilt
                                                          Start measurement

The patient showed a vasovagal syncope type 2b cardioinhibitory with asystolia and
chronotropic incompetence, therefore a DDD-pacemaker was implanted.

                                         .            ,
* Courtesy Prim. Dr. Wolfgang Rainer/OA Dr Kurt Walcher Landeskrankenhaus Knittelfeld                 www.cnsystems.at

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