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Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease

Year 2013, Volume: 18 Issue: 3, 130 - 132, 02.10.2013

Abstract

Abstract. Behcet’s disease (BD) is a systemic inflammatory disorder and cardiac involvement is rare. Head-up tilt test is used for evaluating patients with neurocardiogenic syncope (NCS) and syncope of unknown etiology. A 31-year-old woman was examined for three syncopal episodes during the past two months, all of which preceded by nausea and sweating. Examinations including electrocardiography and echocardiography showed normal findings. A head-up tilt table testing was performed at an angle of 60 degrees. At about 8 minutes, syncope associated with bradycardia and asystole was observed. She became hypotensive, and there was a ventricular asystolic pause lasting 20 seconds, associated with loss of consciousness. She was placed in the supine position and cardiac massage was started. After 20 seconds, she slowly returned to sinus rhythm and regained consciousness. The patient was treated with dual-chamber (DDD-R) pacemaker implantation. During six months of follow-up, no major events occurred.

Key words: Behcet’s disease, Head-up tilt test, vasovagal syncope, asystole

References

  • Wechsler B, Du LT, Kieffer E. Cardiovascular manifestations of Behcet's disease. Ann Med Interne (Paris) 1999; 150: 542-554.
  • Koç Y, Güllü I, Akpek G, et al. Vascular involvement in Behcet's disease. J Rheumotol 1992; 19: 402-403.
  • Almquist A, Goldenberg IF, Milstein S, et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989; 320: 3463
  • Milstein S, Buetikofer J, Lesser J, et al. Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia. J Am Coll Cardiol 1989; 14: 1626-1632.
  • Grubb BP, Temesy-Armos P, Moore J, et al. Headupright tilt-table testing in evaluation and management of the malignant vasovagal syndrome. Am J Cardiol 1992; 69: 904-908.
  • Dhala A, Natale A, Sra J, et al. Relevance of asystole during head-up tilt testing. Am J Cardiol 1995; 75: 251-254.
  • Van Dijk N, Velzeboer SC, Destrée-Vonk A, et al. Psychological treatment of malignant vasovagal syncope due to bloodphobia. Pacing Clin Electrophysiol 2001; 24: 122-124.
  • Barón-Esquivias G, Pedrote A, Cayuela A, et al. Long-term outcome of patients with asystole induced by head-up tilt test. Eur Heart J 2002; 23: 483-4
  • Sutton R. Vasovagal syndrome-could it be malignant? Eur J Cardiac Pacing Electrophysiol 1992; 2: 89.
  • Petersen ME, Williams TR, Gordon C, et al. The normal response to prolonged passive head up tilt testing. Heart 2000; 84: 509-514.
  • Benditt DG, Petersen M, Lurie KG, et al. Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Intern Med 1995; 122: 204-209.
  • Benditt DG, Sutton R, Gammage M, et al. “Ratedrop response” cardiac pacing for vasovagal syncope. Rate-Drop Response Investigators Group. J Interv Card Electrophysiol 1999; 3: 27-33.
  • Ammirati F, Colivicchi F, Santini M. Syncope Diagnosis and Treatment Study Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001; 104: 52-57.
Year 2013, Volume: 18 Issue: 3, 130 - 132, 02.10.2013

Abstract

References

  • Wechsler B, Du LT, Kieffer E. Cardiovascular manifestations of Behcet's disease. Ann Med Interne (Paris) 1999; 150: 542-554.
  • Koç Y, Güllü I, Akpek G, et al. Vascular involvement in Behcet's disease. J Rheumotol 1992; 19: 402-403.
  • Almquist A, Goldenberg IF, Milstein S, et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med 1989; 320: 3463
  • Milstein S, Buetikofer J, Lesser J, et al. Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia. J Am Coll Cardiol 1989; 14: 1626-1632.
  • Grubb BP, Temesy-Armos P, Moore J, et al. Headupright tilt-table testing in evaluation and management of the malignant vasovagal syndrome. Am J Cardiol 1992; 69: 904-908.
  • Dhala A, Natale A, Sra J, et al. Relevance of asystole during head-up tilt testing. Am J Cardiol 1995; 75: 251-254.
  • Van Dijk N, Velzeboer SC, Destrée-Vonk A, et al. Psychological treatment of malignant vasovagal syncope due to bloodphobia. Pacing Clin Electrophysiol 2001; 24: 122-124.
  • Barón-Esquivias G, Pedrote A, Cayuela A, et al. Long-term outcome of patients with asystole induced by head-up tilt test. Eur Heart J 2002; 23: 483-4
  • Sutton R. Vasovagal syndrome-could it be malignant? Eur J Cardiac Pacing Electrophysiol 1992; 2: 89.
  • Petersen ME, Williams TR, Gordon C, et al. The normal response to prolonged passive head up tilt testing. Heart 2000; 84: 509-514.
  • Benditt DG, Petersen M, Lurie KG, et al. Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Intern Med 1995; 122: 204-209.
  • Benditt DG, Sutton R, Gammage M, et al. “Ratedrop response” cardiac pacing for vasovagal syncope. Rate-Drop Response Investigators Group. J Interv Card Electrophysiol 1999; 3: 27-33.
  • Ammirati F, Colivicchi F, Santini M. Syncope Diagnosis and Treatment Study Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001; 104: 52-57.
There are 13 citations in total.

Details

Primary Language English
Journal Section Case Report
Authors

Vural Polat This is me

Ali Kemal Gur This is me

Orhan Dogdu This is me

Publication Date October 2, 2013
Published in Issue Year 2013 Volume: 18 Issue: 3

Cite

APA Polat, V., Gur, A. K., & Dogdu, O. (2013). Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease. EASTERN JOURNAL OF MEDICINE, 18(3), 130-132.
AMA Polat V, Gur AK, Dogdu O. Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease. EASTERN JOURNAL OF MEDICINE. October 2013;18(3):130-132.
Chicago Polat, Vural, Ali Kemal Gur, and Orhan Dogdu. “Prolonged Asystole During Head-up Tilt Testing in a Patient With Behcet’s Disease”. EASTERN JOURNAL OF MEDICINE 18, no. 3 (October 2013): 130-32.
EndNote Polat V, Gur AK, Dogdu O (October 1, 2013) Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease. EASTERN JOURNAL OF MEDICINE 18 3 130–132.
IEEE V. Polat, A. K. Gur, and O. Dogdu, “Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease”, EASTERN JOURNAL OF MEDICINE, vol. 18, no. 3, pp. 130–132, 2013.
ISNAD Polat, Vural et al. “Prolonged Asystole During Head-up Tilt Testing in a Patient With Behcet’s Disease”. EASTERN JOURNAL OF MEDICINE 18/3 (October 2013), 130-132.
JAMA Polat V, Gur AK, Dogdu O. Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease. EASTERN JOURNAL OF MEDICINE. 2013;18:130–132.
MLA Polat, Vural et al. “Prolonged Asystole During Head-up Tilt Testing in a Patient With Behcet’s Disease”. EASTERN JOURNAL OF MEDICINE, vol. 18, no. 3, 2013, pp. 130-2.
Vancouver Polat V, Gur AK, Dogdu O. Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease. EASTERN JOURNAL OF MEDICINE. 2013;18(3):130-2.