Head-up tilt testing potentiated with low-dose sublingual isosorbide dinitrate: a simplified time-saving approach for the evaluation of unexplained syncope

American Heart Journal
F AmmiratiM Santini

Abstract

Head-up tilt testing is widely used in the clinical assessment of patients with unexplained syncope. However, the lack of a standard methodology and the conflicting results concerning sensitivity and specificity of the procedure have prompted further studies to define a more cost-effective approach for tilt testing. Our clinical investigation was undertaken to assess the diagnostic value in unexplained syncope of a simple and time-saving protocol for head-up tilt testing, including low-dose sublingual isosorbide dinitrate administration. A group of 73 consecutive patients (43 women and 30 men, mean age 39.6+/-21.8 years) with unexplained syncope despite conventional clinical cardiovascular and neurologic assessment and 10 asymptomatic control subjects underwent head-up tilt testing with isosorbide dinitrate challenge. Participants were tilted at 60 degrees for 30 minutes without medication; if no symptoms occurred, 1.25 mg of isosorbide dinitrate was administered sublingually and tilting was continued for an additional 15 minutes. During the drug-free phase of the test 14 (19.2%) patients had syncope. After isosorbide dinitrate administration syncope occurred in another 28 patients (38.3%); minor symptoms in association with hy...Continue Reading

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Citations

Aug 8, 2002·Journal of the American Geriatrics Society·Attilio Del RossoUNKNOWN Gruppo Italiano di Studio Della Sincope Dell'anziano
Feb 18, 2010·Pacing and Clinical Electrophysiology : PACE·Thiago da Rocha RodriguesMaria da Consolação Vieira Moreira
Aug 14, 2003·Pacing and Clinical Electrophysiology : PACE·Arnaud J J Aerts
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May 8, 2020·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Alan GarciaJorge Gomez-Flores

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