ABSTRACT
INTRODUCTION: Syncope is a common problem and can lead to serious consequences in the elderly. Tilt test is useful to investigate recurrent syncope, but few studies have investigated the hemodynamic responses of this population to tilt test. OBJECTIVE: To describe the tilt test responses of elderly patients with recurrent syncope of unknown origin and to determine the occurrence of altered cardiovascular autonomic function in a subset of those with the diagnosis of dysautonomic pattern to the tilt test. METHODS: Elderly patients (n=165; >60 years old) who sought medical assistance because of recurrent syncope during 18 months were initially enrolled and submitted to a two-stage, nitroglycerin-potentiated tilt test. A subset of patients who presented with dysautonomic response to tilt test performed clinical autonomic tests. RESULTS: The most frequent cause of syncope during tilt test was the dysautonomic pattern (43%), followed by mixed type neurocardiogenic syncope (35%). Most patients who remained asymptomatic during tilt test showed clear abnormal hemodynamic response during the exam. CONCLUSION: Autonomic dysfunction, which can be found during tilt test, is probably an important cause of syncope in the elderly, regardless of the occurrence of symptoms during the tilt test.
Subject(s)
Geriatric Assessment , Hemodynamics/physiology , Syncope/etiology , Syncope/physiopathology , Tilt-Table Test , Aged , Aged, 80 and over , Blood Pressure/physiology , Female , Heart Rate/physiology , Humans , Male , Prospective Studies , Sensitivity and Specificity , Tilt-Table Test/adverse effectsABSTRACT
The autonomic mechanism that triggered atrial fibrillation in a patient during tilt test was investigated. Neurocardiogenic syncope is often characterized by diminished baroreflex sensitivity during the hypotension period. Increased barorereflex sensitivity preceding the onset of atrial fibrillation in tilt testing may indicate the involvement of a vagally mediated mechanism, as shown in the present case.
Subject(s)
Atrial Fibrillation/physiopathology , Autonomic Nervous System/physiopathology , Baroreflex/physiology , Syncope, Vasovagal/physiopathology , Aged , Female , Humans , Tilt-Table TestABSTRACT
Epilepsy is one of the most frequent causes of neurological disorders in young adults. We report the case of a patient who lived with the diagnosis of refractory epilepsy for twelve years, when actually the cause of the symptoms could be found with the performance of a tilt table test. Cardiologists should be aware of the possible diagnosis of neurocardiogenic syncope in patients previously diagnosed with epilepsy, especially in those with difficult therapeutic control.
