Q J Med 1999; 92: 623-629
© 1999 Association of Physicians
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Tilt table testing in the diagnosis of unexplained syncope
From the Cardiovascular Investigation Unit, Department of Geriatric Medicine, Royal Victoria Infirmary, Newcastle, UK
Professor R.A. Kenny, Cardiovascular Investigation Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP. e-mail: r.a.kenny@ncl.ac.uk
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Introduction |
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While the investigation of the physiological and pathophysiological effects of orthostatic stress induced by head-up tilt table testing in humans began more than 50 years ago,1 it was not until 1986 that the utility of tilt testing in the diagnosis of unexplained syncope was demonstrated.2 In the absence of a `gold-standard' diagnostic test for vasovagal syncope, an appropriate clinical history in association with a positive head-up tilt test currently provides the cornerstone for the diagnosis of vasovagal syncope.3 This article will provide an overview of the rationale for the head-up tilt test in relation to its main diagnostic use, vasovagal syncope, a discussion of the methodological issues surrounding the test and the uses of tilt table testing in the further differential diagnosis of unexplained syncope.
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Vasovagal syncope and the pathophysiological rationale for head-up tilt testing |
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More than 60 years after the introduction of the term `vasovagal syncope' by Lewis,4 the exact mechanisms responsible for loss of consciousness associated with profound
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Indications and contraindications |
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Methodology of the head-up tilt table test |
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Equipment, monitoring and environment
Patient preparation
Tilt angle and duration of the head-up tilt test
Sensitivity and specificity of the head-up tilt table test
Reproducibility of the head-up tilt table test
Positivity of the head-up tilt table test
Pharmacological provocative agents in head-up tilt table testing
Isoproterenol
Nitrates
Other pharmacological provocative agents
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Classification of vasovagal syncope |
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Head-up tilt table testing at the extremes of age |
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Further differential diagnosis of unexplained syncope using tilt table testing |
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References |
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  S. W. Parry, J. C. Gray, J. L. Newton, P. Reeve, D. O'shea, and R. A. Kenny 'Front-loaded' head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope Age Ageing, July 1, 2008; 37(4): 411 - 415. [Abstract] [Full Text] [PDF]
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 J L Hampton, S W Parry, R A Kenny, and J L Newton Lower 24 hour urinary sodium concentrations are associated with more severe symptoms in subjects with vasovagal syncope Heart, June 1, 2004; 90(6): 687 - 688. [Full Text] [PDF]
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 P. E M Smith IF IT'S NOT EPILEPSY . . . J. Neurol. Neurosurg. Psychiatry, June 1, 2001; 70(suppl_2): ii9 - ii14. [Full Text] [PDF]
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 S.W. Parry and R.A. Kenny The management of vasovagal syncope QJM, December 1, 1999; 92(12): 697 - 705. [Full Text] [PDF]
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