Nitrate stimulated tilt table testing: a review of the literature.
نویسنده
چکیده
In clinical practice, upright tilt testing is frequently used to determine the etiology of syncope by trying to induce vasovagal reactions. The importance of the test is underscored by the fact that before the introduction of the test in 1986 by Kenny et al.,1 often expensive cardiac examinations were performed without resulting in a clear diagnosis. The more frequent use of the “passive” unmedicated tilt test also revealed its practical limitations. Not only is the test time consuming, but also the sensitivity in unselected populations appears not to be as high as originally described.2 Therefore, a pharmacologic stimulation with isoproterenol was introduced. This resulted in an important increase in sensitivity, even though specificity tended to decrease, especially at higher doses. The widespread use of isoproterenol as a provocative stimulus during tilt testing also revealed its limitations. Reports of supraventricular arrhythmias, variant angina pectoris, and even ventricular fibrillation in patients with structural heart disease, during isoproterenol stimulated tilt testing, make the use of isoproterenol less desirable in unselected patient groups.3 In addition, the intravenous cannulation itself may result in an important decrease in specificity.4 Therefore, an alternative was sought and found in nitrates. These compounds are well known for their ability to induce vasovagal syncope. Raviele et al.5 was the first in 1993 to publish about the value of intravenous nitrates during head-up tilt testing in patients with syncope of unknown origin. Since then several authors reported about the use of, oral and intravenous, nitrates for stimulation during tilt testing.5−21 The aim of this article was to review the history and data on how nitrates provoke syncope and the present state of use of nitrates during tilt table testing.
منابع مشابه
DI AGNOSTIC VAL UE OF SUBL INGUAL NITROGLYCERIN TILT TEST: COMPARISON WITH THE STANDARD ISOPROTERENOL TILT TEST
Sublingual nitroglycerin (TNG) has been introduced as a promising provocative agent for tilt table testing, but it has not been compared directly with the standard isoproterenol (ISO) infusion test previously. We tried to assess the diagnostic value and safety of TNG tilt testing as compared with ISO infusion in patients with unexplained syncope. TNG and ISO tilt tests were performed in tw...
متن کاملByung Gyu Kim et al.: Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test
BACKGROUND Nitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT. METHODS We evaluate...
متن کاملTilt Table Practice Improved Ventilation in a Patient with Prolonged Artificial Ventilation Support in Intensive Care Unit
Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impair-ments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is no...
متن کاملUtility of a single-stage isoproterenol tilt table test in adults: a randomized comparison with passive head-up tilt.
OBJECTIVES This study was conducted to develop a time-efficient tilt table test. BACKGROUND Current protocols of tilt table testing are quite time-consuming. This study was designed to assess the diagnostic value, tolerance and procedural time of a single-stage isoproterenol tilt table protocol. METHODS A single-stage isoproterenol tilt table test was compared with the passive tilt table te...
متن کاملSyncope as a health risk for soldiers - influence of medical history and clinical findings on the sensitivity of head-up tilt table testing.
BACKGROUND Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography abnormalities can be used to predict the succe...
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ورودعنوان ژورنال:
- Pacing and clinical electrophysiology : PACE
دوره 26 7 Pt 1 شماره
صفحات -
تاریخ انتشار 2003