Cerebral Oxygenation in Children with Syncope During Head-Upright Tilt Test

1997 ◽  
Vol 18 (6) ◽  
pp. 406-409 ◽  
Author(s):  
A. Rodríguez–Núñez ◽  
J. Couceiro ◽  
C. Alonso ◽  
J. Eirís ◽  
M. Fuster ◽  
...  
Keyword(s):  
Cerebral Oxygenation ◽  
Tilt Test ◽  
Upright Tilt ◽  
Head Upright Tilt Test

Usability of the head upright tilt test for differentiating between syncopal and seizure-like events in children

2015 ◽  
Vol 115 (4) ◽  
pp. 575-579
Author(s):  
Reza Azizi Malamiri ◽  
Ali Akbar Momen ◽  
Ali Nikkhah ◽  
Mohammad Reza Khalilian ◽  
Mehdi Ghaderian ◽  
...  
Keyword(s):  
Tilt Test ◽  
Upright Tilt ◽  
Head Upright Tilt Test

Usefulness of the Head-Upright Tilt Test for Distinguishing Syncope and Epilepsy in Children

Epilepsia ◽  
2001 ◽  
Vol 42 (6) ◽  
pp. 709-713 ◽  
Author(s):  
J. Eirís-Puñal ◽  
A. Rodríguez-Núñez ◽  
N. Fernández-Martínez ◽  
M. Fuster ◽  
M. Castro-Gago ◽  
...  
Keyword(s):  
Tilt Test ◽  
Upright Tilt ◽  
Head Upright Tilt Test

Abstract 302: Negative Effects of Fludrocortisone Treatment in Adolescents with POTS and Syncope

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Hossam A Shaltout ◽  
John E Fortunato ◽  
Debra I Diz
Keyword(s):  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Mean Square ◽  
Negative Effects ◽  
Time Points ◽  
Treatment Support ◽  
Pharmacologic Agents ◽  
Upright Tilt

Fludrocortisone (Florinef) is commonly used to treat symptoms associated with postural orthostatic tachycardia syndrome (POTS). We have previously shown that Florinef treatment in children with POTS improved the changes in baroreflex sensitivity (BRS) and heart rate variability (HRV) measured as the root of mean square of successive differences (rMSSD) during upright tilt compared to untreated children with POTS. We noticed that a subgroup of our patients experienced POTS symptoms followed by syncope at later time points during the 45 min tilt test in both Florinef treated and untreated groups. We stratified based on syncope and compared the effect of Florinef treatment on both groups. Of the 32 POTS patients studied (15.0 ± 0.6 yrs old), 14 were treated with Florinef of whom 5 had syncope, and 18 were untreated of whom 5 had syncope. In the non-syncopal group, subjects treated with Florinef for a minimum of 4 wks compared with untreated POTS without syncope had similar baseline supine measures of MAP, HR, BRS and HRV before tilt, and less reduction in BRS during tilt measured as Seq UP (-7.1 ± 2.5 vs -15.1 ± 3.5 ms/mmHg; p<0.03), a trend for less attenuation in HRV (-22.4 ± 6.4 vs -35.3 ± 6.3 ms; p<0.07) and reduced tachycardia with tilt (25 ± 6 vs 38 ± 4 beats/min; p<0.02) compared with the untreated group. Meanwhile, in the syncopal group, Florinef-treated patients at baseline in the supine position before tilt had worse BRS function measured as Seq UP compared to untreated (11.9 ± 2.2 vs 26.0 ± 6.7 ms/mm Hg; p<0.04), a tendency for lower HRV (40.8 ± 7 vs 61.2 ± 12 ms; p<0.08) and higher HR (82 ± 3 vs 65 ± 7 beats/min; p<0.02) than untreated POTS patients with syncope. In contrast to non-syncopal POTS, the HR increase during tilt in syncopal POTS subjects was not reduced by the Florinef. The impairments in baseline supine autonomic function in POTS with syncope patients treated with Florinef relative to untreated patients and lack of improvement in the performance upon upright tilt suggests that POTS patients should be stratified by syncope status during the tilt test prior to assigning this treatment regimen. Additional studies are needed to better define these patients and to determine if other pharmacologic agents would provide a more optimal treatment. Support: AHA12CRP9420029

Similar Cerebral Blood Flow and Autonomic Responses to Upright Tilt Test in Adult Patients With Different Hemodynamic Mechanisms Leading to Reflex Syncope

2020 ◽  
Vol 37 (3) ◽  
pp. 239-245
Author(s):  
J. Antonio González-Hermosillo ◽  
Alvaro Petersen ◽  
Cecy Salas-Herrera ◽  
Christopher Brown-Escobar ◽  
Andrey Kostine ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Adult Patients ◽  
Tilt Test ◽  
Autonomic Responses ◽  
Reflex Syncope ◽  
Upright Tilt

Reproducibility of a positive passive upright tilt test at a seven-day interval in patients with syncope

1993 ◽  
Vol 72 (5) ◽  
pp. 469-471 ◽  
Author(s):  
Jean-Jacques Blanc ◽  
Jacques Mansourati ◽  
Benoit Mahe ◽  
Driss Boughaleb ◽  
Loïc Genet
Keyword(s):  
Tilt Test ◽  
Upright Tilt

P5678Near-infrared spectroscopy (NIRS) in the evaluation of psychogenic pseudosyncope - Moving towards a simplified diagnostic pathway

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Claffey ◽  
L Perez-Denia ◽  
G Rivasi ◽  
A Ungar ◽  
C Finucane ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Cerebral Perfusion ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Diagnostic Yield ◽  
Case Series ◽  
Cerebral Hypoperfusion ◽  
Tilt Test ◽  
Eyes Closed ◽  
Unexplained Syncope

Abstract Background Psychogenic pseudosyncope (PPS) is a conversion disorder that often mimics syncope, is commonly referred to cardiology clinics and accounts for a large proportion of patients admitted with “unexplained syncope”. Unlike syncope, PPS is characterized by normal blood pressure (BP) and heart rate (HR) values at TLOC inferring the absence of cerebral hypoperfusion. The current gold standard for the diagnosis of PPS is the reproduction of patients' symptoms during a head-up tilt test (HUTT) with concurrent electroencephalogram (EEG) monitoring showing normal haemodynamic and brainwave measurements. However, EEG is time consuming, resource intensive and many syncope units lack ready access, thereby solely relying on absence of peripheral haemodynamic changes to diagnose PPS. Purpose Near-infrared spectroscopy (NIRS) is a non-invasive technology used for continuous monitoring of cerebral oxygenation. Measuring adequacy of tissue oxygenation is an appropriate surrogate for cerebral perfusion. In this study, we present a case series of patients for whom the diagnosis of PPS was confirmed by NIRS during TLOC. We propose use of NIRS in routine clinical assessment of suspected PPS. Methods We describe nine consecutive patients with suspected PPS referred to a dedicated syncope unit for investigation of recurrent unexplained syncope. All patients underwent evaluation in accordance with European Society of Cardiology guidelines including HUTT. Continuous beat-to-beat BP and HR measurements were recorded using finger plethysmography. In addition, continuous NIRS-derived tissue saturation index (TSI) - a measure of percentage oxygenation - was recorded using an optical sensor applied to the left lateral forehead to assess cerebral perfusion. Absolute values of BP, HR and TSI at baseline, time of first symptom onset, presyncope and apparent TLOC were recorded. The evaluation was diagnostic for PPS when apparent TLOC occurred in the absence of typical haemodynamic or cerebral perfusion changes. Results The median age was 35 years (range 14–54). Clinical features were consistent with those previously described in PPS literature - female preponderance, comorbid psychiatric diagnosis, frequent attack history, with prolonged TLOC and eyes closed during events. During HUTT, all patients experienced an apparent TLOC which they recognised as reproductive of typical events. BP and HR measurements increased significantly at time of TLOC. There was no significant change in TSI at any of the time points throughout HUTT. (Figure 1 shows averaged absolute values of systolic and diastolic BP, HR and TSI with median values represented by thickened lines.) Figure 1. Measurements during HUTT Conclusion NIRS is readily available, easily accessible and provides an appropriate surrogate measure of cerebral perfusion during HUTT. We propose that HUTT incorporating concurrent NIRS monitoring will enhance diagnostic yield and patient management providing important biofeedback.

Divided left atrium (cor triatriatum sinistrum) presenting with syncope

1994 ◽  
Vol 4 (1) ◽  
pp. 69-70
Author(s):  
Angelo Camerieri ◽  
Giacomo Pongiglione ◽  
Alberto Bertolini
Keyword(s):  
Left Atrium ◽  
Asymptomatic Patient ◽  
Surgical Correction ◽  
Cor Triatriatum ◽  
Tilt Test ◽  
Mode Of Presentation ◽  
Upright Tilt

SummarySyncope has never been described as the presenting symptom of divided left atrium (cor triatriatum sinistrum). We have now encountered this mode of presentation in an otherwise asymptomatic patient. An upright tilt test elicited syncope prior to surgical correction, but failed to induce any symptom, even subsequent to infusion of isoproterenol, after surgery.

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