| Usefulness of head-up tilt test in evaluating patients with syncope of unknown origin and negative electrophysiologic study. | |
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MedLine Citation:
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PMID: 1971497 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The vasovagal nature of syncope, which remained unexplained despite full clinical and electrophysiologic investigation, was evaluated by means of 60 degrees head-up tilt test for 60 minutes. Thirty patients (17 men and 13 women, mean age 65 years, 19 with and 11 without organic heart disease) with 1 to 28 (mean 5) episodes of syncope of unknown origin were studied. Head-up tilt test was considered positive if syncope developed in association with hypotension, bradycardia, or both. During baseline head-up tilt 15 patients (50%) had a positive response. Ten patients had a vasodepressor response (marked hypotension without marked bradycardia) and 5 had a mixed response (marked hypotension with marked bradycardia). None of 8 control subjects became symptomatic during the test. Baseline head-up tilt test was positively reproducible in 10 of 14 patients (71%). Nine of these 10 patients underwent serial head-up tilt tests after drug administration to determine the pathogenesis of vasovagal syncope. Atropine prevented tilt-induced syncope in 3 of 8 patients (37.5%), propranolol in 2 of 8 (25%) and etilephrine in 7 of 7 (100%). Seven patients received long-term drug treatment with drugs selected on the basis of acute drug testing. One responder to atropine received transdermal scopolamine and 6 received etilephrine. None of these 7 patients had syncopal recurrences or death during a mean follow-up of 12 months. Head-up tilt is a very sensitive and highly specific test to unmask susceptibility to vasovagal reaction in patients with syncope of unknown origin. Withdrawal of alpha-sympathetic stimulation is a principal mechanism responsible for vasodilation and syncope during head-up tilt.(ABSTRACT TRUNCATED AT 250 WORDS) |
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Authors:
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A Raviele; G Gasparini; F Di Pede; P Delise; A Bonso; E Piccolo |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of cardiology Volume: 65 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1990 Jun |
Date Detail:
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Created Date: 1990-06-25 Completed Date: 1990-06-25 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1322-7 Citation Subset: AIM; IM; S |
Affiliation:
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Division of Cardiology, Umberto I Hospital, Mestre, Venice, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic alpha-Agonists
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therapeutic use Aged Atropine / therapeutic use Bradycardia / etiology* Electrocardiography Electrophysiology Female Heart / physiopathology* Humans Hypotension, Orthostatic / etiology* Male Posture* Propranolol / therapeutic use Syncope / etiology*, prevention & control |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic alpha-Agonists; 51-55-8/Atropine; 525-66-6/Propranolol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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