QUANTITATIVE TILT-TABLE EXAMINATION WITH TCD MONITORING IN THE DIAGNOSIS OF NEUROCARDIOGENIC SYNCOPE (VASOVAGAL SYNCOPE)

The clincal significance of quantitative tilt-table examination with T CD monitoring in the diagnosis of neurocardiogenic syncope is evaluate d. A 50-year-old male suffered a neurocardiogenic syncope during tilt- table examination with a strong drop in blood pressure, an increase in cerebrovascular resistance as evidenced by transcranial Doppler monit oring, and a 30-s cardiac asystole, followed by a generalized seizure. No further syncope could be elicited during tilt-table examination af ter beta-blocker treatment, It was hypothesized that hyperactivity of the left ventricular mechanoreceptors due to increased force of ventri cular contraction during a state of reduced venous backstream to the h eart was responsible for eliciting the neurocardiogenic syncope. Tilt- table examination with an upright position for at least 45 min enables the diagnosis of a neurocardiogenic syncope to be made with sufficien t sensitivity and specificity. Several studies have shown that medicat ion with beta-blockers is successful in the treatment of neurocardioge nic syncope. The implantation of cardiac pacemakers should only be con sidered if medication is not successful.