Head-up tilt test: A highly sensitive,specific test for children with unexplained syncope |
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Authors: | D Alehan A Çeliker ? Özme |
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Institution: | (1) Department of Pediatric Cardiology, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey |
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Abstract: | Unexplained syncope may cause diagnostic and therapeutic problems in children. The head-up tilt test has been shown to be
a useful tool for investigating unexplained syncope, especially for diagnosis of neurally mediated syncope. In this study
20 patients aged 9–18 years (12.0±2.5 years) with syncope of unknown origin and 10 healthy age-matched children were evaluated
by head-up tilt to 60° for 25 minutes. The test was considered positive if syncope or presyncope developed in association
with hypotension, bradycardia, or both. If tilting alone did not induce symptoms (syncope or presyncope), isoproterenol infusion
was administered with increasing doses (0.02–0.08 μg/kg per minute). During the tilt test, symptoms were elicited in 15 (75%)
of the patients with unexplained syncope but in only one (10%) of the control group (p<0.001). The sensitivity of the test was 75% and its specificity 90%. Three patterns of response to upright tilt were observed
in symptomatic patients: vasodepressor pattern with an abrupt fall in blood pressure in 67%; cardioinhibitory pattern with
profound bradycardia in 6%; and mixed pattern in 27%. In patients with positive head-up tilt, there were sudden decreases
in systolic blood pressure (from 130±15 to 61±33 mmHg) and in mean heart rate (from 147±26 to 90±38 beats per minute) (p<0.001) during symptoms. Treatments with atenolol 25 mg/day has shown complete suppression of syncope in positive responders
during a mean follow-up period of 18±6 months. The head-up tilt test is a noninvasive, sensitive, specific diagnostic tool
for evaluating children with unexplained syncope. |
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Keywords: | Head-up tilt test Children Syncope Sensitivity Specificity |
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