Journal
EUROPEAN HEART JOURNAL
Volume 42, Issue 17, Pages 1654-1660Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehab084
Keywords
Tilt-table test; Vasovagal syncope; Syncope; Orthostatic hypotension; Postural orthostatic tachycardia syndrome; Psychogenic pseudosyncope; Active stand; ECG-loop recorders
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Head-up tilt test is a clinical tool used for studying heart rate/blood pressure adaptation, modeling responses to hemorrhage, assessing orthostatic hypotension, etc. It has diagnostic value in syncope but also has limitations.
Head-up tilt test (TT) has been used for >50 years to study heart rate/blood pressure adaptation to positional changes, to model responses to haemorrhage, to assess orthostatic hypotension, and to evaluate haemodynamic and neuroendocrine responses in congestive heart failure, autonomic dysfunction, and hypertension. During these studies, some subjects experienced syncope due to vasovagal reflex. As a result, tilt testing was incorporated into clinical assessment of syncope when the origin was unknown. Subsequently, clinical experience supports the diagnostic value of TT. This is highlighted in evidence-based professional practice guidelines, which provide advice for TT methodology and interpretation, while concurrently identifying its limitations. Thus, TT remains a valuable clinical asset, one that has added importantly to the appreciation of pathophysiology of syncope/collapse and, thereby, has improved care of syncopal patients. [GRAPHICS] .
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