Tilt table testing in syncope Nursing practice NHS and health

							 TILT TABLE TESTING IN SYNCOPE
The Activities on these Portfolio Pages correspond with the learning objectives
of the Guided Learning unit published in Nursing Times 104: 20 (20 May 2008)
and 104; 21 (27 May 2008). The full reference list for this unit follows Activity 4.

Before starting to work through these Activities, save this document onto your
computer, then print the completed work for your professional portfolio.
Alternatively, simply print the pages if you prefer to work on paper, using extra
sheets as necessary.

Recording your continuing professional education
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period, make a note in the box below of the date and the total number of hours
you spent on reading the unit and any other relevant material, and working
through the Activities.


 Hours:                        Date:


 ACTIVITY 1

Learning objective: Understand the
importance of tilt table testing in the
evaluation of patients who collapse.

Activity: A 38-year-old HGV driver
presents with dizzy spells. His GP is
concerned about his driving and has
referred him for further assessment.
Describe how this patient would be
investigated.


 RESPONSE

Begin your response here.




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ACTIVITY 2                                                 explanation of the procedure, why it is
                                                           necessary and any possible
                                                           complications.
Learning objective: Know how tilt table
testing is carried out.
                                                               RESPONSE
Activity: A 70-year-old man is about to
undergo tilt table testing for suspected                   Begin your response here.
carotid sinus syndrome. Give him an




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ACTIVITY 3                                                 Explain what lifestyle advice you would
                                                           give to him and his wife, as both are
                                                           concerned about his recurrent syncope
Learning objective: Understand the
impact syncope can have on patients’
lives and the measures that can be taken                       RESPONSE
to reduce further episodes.
                                                           Begin your response here.
Activity: A 78-year-old man presents
with diagnosed vasovagal syncope.




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ACTIVITY 4                                                 clinical presentation, investigation and
                                                           diagnosis.
Learning objective: Know how to
differentiate between types of syncope.

Activity: A 70-year-old man collapsed                          RESPONSE
while attending his son’s wedding
reception. List three possible causes of                   Begin your response here.
his syncope with a description of its




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FULL REFERENCE LIST                                        of Internal Medicine; 163: 151-162.

                                                           Grubb, B.P. (2000) Orthostatic intolerance.
Anderson, J., Smith, P. (2007) ‘Collapse?                  National Dysautonomia Research
Cause’ – avoiding misdiagnosis in falls.                   Foundation Patient Conference.
ACNR (Advances in Clinical Neuroscience                    Minneapolis, Minnesota.
and Rehabilitation); 7: 4.
www.acnr.co.uk/SO07/ACNR_SO07_collap                       Grubb, B.P. (1999) Pathophysiological and
se.pdf                                                     differential diagnosis of neurocardiogenic
                                                           syncope. American Journal of Cardiology;
Benditt, D.G. et al (1996) ACC expert                      84: 3-9.
consensus document: tilt table testing for
assessing syncope. Journal of the                          Hermosillo, A.G. et al (2001) Orthostatic
American College of Cardiology; 28: 1,                     hypotension. Cardiology in Review; 9: 6,
263-75.                                                    339-347.
www.cardiosource.com/guidelines/consens                    Kenny, R.A. et al (2000) The Newcastle
us/tilt.pdf                                                protocols for head-up tilt table testing in the
                                                           diagnosis of vasovagal syncope, carotid
Brignole, M. et al (2004) Guidelines on                    sinus hypersensitivity and related
management (diagnosis and treatment of                     disorders. Heart; 83: 564-9.
syncope): Update. European Heart Journal;                  McIntosh, S. et al (1993) Outcome of an
24: 22, 2054-2072.                                         integrated approach to the investigation of
                                                           dizziness, falls and syncope in elderly
Davies, A.J., Kenny, R.A. (1998)                           patients referred to a ‘syncope’ clinic. Age
Frequency of neurological complications                    and Ageing; 22: 1, 53-8.
following carotid sinus massage. American
Journal of Cardiology; 81: 1256-7.                         Parry, S.W., Kenny R.A. (1999) The
                                                           management of vasovagal syncope. QJM;
Frishman, W.H. et al (2003) Drug                           92: 697-705.
treatment of orthostatic hypotension and
vasovagal syncope. Heart Disease; 5: 1,                    Sclater, A., Alagiakrishnan, K. (2004)
49-64.                                                     Orthostatic hypotension. A primary care
                                                           primer for assessment and treatment.
Goldschlager, N. et al (2003) Etiological                  Geriatrics; 59: 8, 22-27.
considerations in the patient with syncope
and an apparently normal heart. Archives




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CAUSES OF SYNCOPE


   Cardiac
    Arrhythmias
    Heart valve abnormalities
    Cardiomyopathy

  Non-cardiac
   Medication e.g., sedatives, anti-
    hypertensives
   Hypoglycaemia
   Dehydration
   Vasovagal
   Orthostatic hypotension
   Seizure
   Unknown




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