VALUE OF HEAD-UP TILT TESTING POTENTIATED WITH SUBLINGUAL NITROGLYCERIN TO ASSESS THE ORIGIN OF UNEXPLAINED SYNCOPE

被引:202
作者
RAVIELE, A
MENOZZI, C
BRIGNOLE, M
GASPARINI, G
ALBONI, P
MUSSO, G
LOLLI, G
ODDONE, D
DINELLI, M
MUREDDU, R
机构
[1] OSPED S MARIA NUOVA,ARRHYTHMOL SECT,REGGIO EMILIA,ITALY
[2] OSPED RIUNITI,ARRHYTHMOL SECT,LAVAGNA GENOA,ITALY
[3] OSPED CIVILE,DIV CARDIOL,CENTO FERRARA,ITALY
[4] OSPED CIVILE,ARRHYTHIMOL SECT,I-18100 IMPERIA,ITALY
关键词
D O I
10.1016/S0002-9149(99)80079-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This study was undertaken to assess the value of sublingual nitroglycerin administration during upright tilt as a simple practical test for the diagnosis of vasovagal syncope. To this purpose, 235 patients with syncope of unknown origin and no evidence of organic heart disease (110 men, mean age 52 +/- 20 years) and 35 asymptomatic control subjects underwent head-up tilt testing with nitroglycerin challenge. Patients and subjects were tilted at 60 degrees for 45 + 20 minutes; the initial 45 minutes were without medication and the final 20 minutes after 300 mu g of sublingual nitroglycerin. During the drug-free phase of the test, 59 patients (25%) and no controls had a positive response. After drug administration, a positive response (syncope in association with sudden hypotension and bradycardia) occurred in 60 patients (26%) and in 2 controls (6%), whereas an exaggerated or false-positive response (minor or different symptoms in association with slowly increasing hypotension alone) was observed in 33 patients (14%) and in 5 controls (14%). We conclude that the sublingual nitroglycerin head-up tilt test is a useful tool to unmask the vasovagal origin of unexplained syncope in patients without organic heart disease. The addition of nitroglycerin to upright tilt allows the positive rate of passive tilting to be doubled (51% vs 25%) while maintaining a high specificity (94% vs 100%).
引用
收藏
页码:267 / 272
页数:6
相关论文
共 29 条
[1]   VENTRICULAR SYNCOPE - IS THE HEART A SENSORY ORGAN [J].
ABBOUD, FM .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (06) :390-392
[2]   PROVOCATION OF BRADYCARDIA AND HYPOTENSION BY ISOPROTERENOL AND UPRIGHT POSTURE IN PATIENTS WITH UNEXPLAINED SYNCOPE [J].
ALMQUIST, A ;
GOLDENBERG, IF ;
MILSTEIN, S ;
CHEN, MY ;
CHEN, XC ;
HANSEN, R ;
GORNICK, CC ;
BENDITT, DG .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (06) :346-351
[3]   TILT TABLE TESTING FOR EVALUATION OF NEURALLY-MEDIATED (CARDIONEUROGENIC) SYNCOPE - RATIONALE AND PROPOSED PROTOCOLS [J].
BENDITT, DG ;
REMOLE, S ;
BAILIN, S ;
DUNNIGAN, A ;
ASSO, A ;
MILSTEIN, S .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1991, 14 (10) :1528-1537
[4]   NEURALLY MEDIATED SYNCOPE DETECTED BY CAROTID-SINUS MASSAGE AND HEAD-UP TILT TEST IN SICK SINUS SYNDROME [J].
BRIGNOLE, M ;
MENOZZI, C ;
GIANFRANCHI, L ;
ODDONE, D ;
LOLLI, G ;
BERTULLA, A .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 68 (10) :1032-1036
[5]   CAROTID-SINUS MASSAGE, EYEBALL COMPRESSION, AND HEAD-UP TILT TEST IN PATIENTS WITH SYNCOPE OF UNCERTAIN ORIGIN AND IN HEALTHY CONTROL SUBJECTS [J].
BRIGNOLE, M ;
MENOZZI, C ;
GIANFRANCHI, L ;
ODDONE, D ;
LOLLI, G ;
BERTULLA, A .
AMERICAN HEART JOURNAL, 1991, 122 (06) :1644-1651
[6]   COMPARISON OF RESPONSES TO ISOPROTERENOL AND EPINEPHRINE DURING HEAD-UP TILT IN SUSPECTED VASODEPRESSOR SYNCOPE [J].
CALKINS, H ;
KADISH, A ;
SOUSA, J ;
ROSENHECK, S ;
MORADY, F .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 67 (02) :207-209
[7]  
Cicogna R, 1992, G Ital Cardiol, V22, P1367
[8]   NITROGLYCERIN-INDUCED SEVERE HYPOTENSION AND BRADYCARDIA IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION [J].
COME, PC ;
PITT, B .
CIRCULATION, 1976, 54 (04) :624-628
[9]   METHODOLOGY OF HEAD-UP TILT TESTING IN PATIENTS WITH UNEXPLAINED SYNCOPE [J].
FITZPATRICK, AP ;
THEODORAKIS, G ;
VARDAS, P ;
SUTTON, R .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1991, 17 (01) :125-130
[10]   UTILITY OF UPRIGHT TILT-TABLE TESTING IN THE EVALUATION AND MANAGEMENT OF SYNCOPE OF UNKNOWN ORIGIN [J].
GRUBB, BP ;
TEMESYARMOS, P ;
HAHN, H ;
ELLIOTT, L .
AMERICAN JOURNAL OF MEDICINE, 1991, 90 (01) :6-10