TILTING TABLE TEST IN THE DIAGNOSIS OF VA SOVAGAL SYNCOPE - DIAGNOSTIC GAIN FROM ISOPRENALINE INJECTION

Objective: The cause of syncope remains unclear in half of the cases, even after extensive neurological and cardiological examination. A stu dy was, therefore, undertaken to determine the number of patients with the suspected diagnosis of vasovagal syncope that were confirmed by t he tilting table test and how often it required the additional adminis tration of isoprenaline to do so. Patients and methods: A tilting tabl e test was performed on 75 patients (49 men, 26 women; mean age 41 [17 -80] years) with syncopes of uncertain cause, previous examinations ha ving failed to discover any neurological or cardiological cause. The t est was done with a head-up angle of 60 degrees for 30 min. ECG and ar terial blood pressure by indwelling catheter were recorded continuousl y. if the test was negative, isoprenaline was given intravenously at a rate of 5 mu g/min during a five-minute period in the horizontal posi tion, followed by 10 minutes at 60 degrees head-up position. Results: Vasovagal syncope or presyncope was induced in 49 of the 75 patients d uring the tilting table test, a sensitivity of 65%. But 45% of the tes ts were positive only with the administration of isoprenaline, i.e. an increase in sensitivity to 81.5%. In 96% of the patients with a posit ive test there was conformity of symptoms between the induced acid the spontaneously occurring syncopes. Conclusion: The tilting table test is a valuable means of investigating cases of syncope. More than half of the cases of syncope of uncertain cause can be correctly diagnosed classified in this way. The additional use of isoprenaline infusion gr eatly increases the sensitivity of the method.