Syncope other diagnostic studies

Other diagnostic studies for syncope include the tilt table test and exercise stress test. The tilt table test is especially useful in differentiating syncope from other possible causes of transient loss of consciousness, such as epilepsy and conversion disorder. A tilt table test can help reveal Vasovagal syncope or hypotensive syncope. The patient is on a table tilted at 70 degrees for 45 minutes. A positive test is defined as induced hypotension with or without bradycardia or asystole suggestive of vasovagal syncope. If hypotension occurs within the first 3 minutes of test, orthostasis hypotension is possible. In delayed orthostasis hypotension, a fall in blood pressure occurs after 3 minutes. An exercise stress test (EST) is recommended in the presence of syncope during exercise or syncope during the occurrence of angina pectori suspected myocardial ischemia. Contraindications for EST in patients with syncope include: hypertrophic obstructive cardiomyopathy, severe aortic stenosis, catecholaminegic polymorphic ventricular tachycardia(CPVT), pulmonary artery hypertension, interarterial anomalous coronary artery , and long QT syndrome type 1.

Other diagnostic studies for syncope include:^[1]

• Tilt table test can help to reveal vasovagal syncope or hypotesive syncope.
  • Tilt table test is especially useful in differentiating syncope from other possible causes of transient loss of consciousness, such as epilepsy and conversion disorder.^[1]
  • The patient is on the table tilted at 70 degrees for 45 minutes.
  • A positive test is defined induced hypotension with or without bradycardia or asystole suggestive of vasovagal syncope.
  • If hypotension occurs within the first 3 minutes of the test, orthostasis hypotension is possible. In delayed orthostasis hypotension, falling in blood pressure occurs after 3 minutes.
• Exercise stress test (EST) is recommended in the presence of syncope during exercise or syncope during the occurrence of angina Pectoris suspected myocardial ischemia. ( Class 2a, 2017 AHA/ACC/HRS Guideline).

• Contraindications for EST in patients with syncope include:

• Hypertrophic obstructive cardiomyopathy, severe aortic stenosis
• Catecholaminegic polymorphic ventricular tachycardia(CPVT)
• Pulmonary artery hepertension
• Interarterial anomalous coronary artery
• Long QT syndrome type 1

A tilt table test can help to reveal abnormal cardiovascular reflexes that produce syncope. During the test, you stand and your initial blood pressure and heart rate are recorded as the baseline. Then the table is tilted at 70 degrees for 45 minutes. Your blood pressure and heart rate are recorded again. At the same time, the nurse observes whether symptoms such as nausea or vomiting appear. A positive result suggests the possibility of vasovagal syncope. {{#ev:youtube|-t-ZhMssEbE}}