TILT TEST

SYNCOPE

Also known as fainting or lypotimia, is clinically characterized by sudden and transient loss of consciousness associated with loss of postural status of the patient. In most cases is followed by a spontaneous recovery of the patient. It is benign but can sometimes be a warning sign prior to episodes of sudden death.

PRESYNCOPE

Feeling slight loss of consciousness but without losing it entirely.

NEUROCARDIOGENIC SYNCOPE

Clinical situation which is characterized by sudden or temporary loss of consciousness, with the sudden failure of autonomic nervous system. The patient is unable to maintain adequate hemodynamic status and blood pressure or heart rate which causes an insufficient level of cerebral perfusion and loss of consciousness.

INCIDENCE

The event of syncope can be the cause of 3.5 percent of visits to the emergency room meriting from 1 to 6 percent of hospital admissions. The incidence of such symptoms is 3% in men and 3.5% in women, which increases with age: 0.7 percent in adults 35 to 42 years increasing to 6 percent in individuals over 75 years of age.

CAUSES

• Hypotension

• Cardiac Arrhythmias

• Structural heart or cardiopulmonary disease

• Cerebrovascular disease

• Neuromediator disorders

TILT TEST

Is a non-invasive test to determine the cause of syncope especially if it is is suspected to be mainly of a neurocardiogenic origin or neurologically mediated. Its sensitivity is 75 percent and specificity 88 percent. It may present false-negative results in 30 percent of cases. It is recommended in cases where there have been recurrent episodes of syncope without a definite cause or in those cases where such symptoms occur in patients with high-risk occupations (air pilots, drivers, athletes).

PREPARATION

• 4 hours of fasting

• No coffee and soft drinks 12 hours before the test

• No smoking in the last 6 hours

• Stopping beta blockers two days before the test, such as Tenormin, Coreg, Prolaken, Inderal, Atenolol, Propranolol, Bisoprolol, metoprolol, carvedilol, sotalol, Nebibolol

The child must be accompanied by a family member, dressed in comfortable clothes (two-piece). It is important to have ruled out anemia, electrolyte disturbances, history of angina or previous heart attack, stroke or transient cerebral ischemic episodes, convulsive syndrome, valvular disease, peripheral (coronary, carotid, aorta), pregnancy or suspected pregnancy.

THE STUDY

The patient is placed on a special table which can tilt, after which a saline solution (with a slow drip) is injected in the vein. The patient is secured to the stretcher bands to avoid falling and trauma. The patient is monitored at baseline (electrocardiogram, blood pressure) then it is placed at 70 ° degrees and is monitored with several records of electrocardiogram and blood pressure.

If the patient does not present any disorder after being for 20 to 30 minutes in this position, the patient is stimulated with sublingual nitrate continuing with such monitoring. If the patient experiences syncope or presyncope or changes in heart rate or blood pressure the test is considered positive and is terminated.

RISK

Complications are rare during the test so the patient and family should be made aware of this. Signed consent of the patient and family should be obtained prior to the test, especially with children.