Who should have a tilt test?
Kenny et alin 1986 were the first to demonstrate the value of head
up tilt testing in the diagnosis of unexplained syncope.^1 There is a
broad group of hypotensive syndromes and conditions where
head up tilt testing should be considered – patients with recurrent
syncope or presyncope and high risk patients with a history of a
single syncopal episode (serious injury during episode, driving)
where no other cause for symptoms is suggested by initial history,
examination or cardiovascular and neurological investigations.
Tilt table testing may also be of use in the assessment of elderly
patients with recurrent unexplained falls and in the differential
diagnosis of convulsive syncope, orthostatic hypotension,
postural tachycardia syndrome, psychogenic and hyper-
ventilation syncope and carotid sinus hypersensitivity.
What do you do if you make a diagnosis of vasovagal syncope
on history and head up tilt test?
As a result of the complexity of the aetiology of vasovagal syncope
and the lack of a single well evaluated therapeutic intervention
there are many treatments available. These have recently been
reviewed,^2 and the following algorithm for management of vaso-
vagal syncope suggested (Algorithm 75.1).
RReeffeerreenncceess
1 Kenny RA, Ingram A, Bayliss J et al. Head-up tilt: a useful test for
investigating unexplained syncope. Lancet1986;ii: 1352–4.
2 Parry SW, Kenny RA. The management of vasovagal syncope. Q J Med
1999; 9922 : 697–705.
FFuurrtthheerr rreeaaddiinngg
Kenny RA, O’Shea D, Parry SW. The Newcastle protocols for head-up tilt
table testing in the diagnosis of vasovagal syncope and related disorders.
Heart2000; 8833 : 564–9.