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A Case of Prolonged Asystole During Head-up Tilt Testing

Year 2012, Volume: 2 Issue: 2, - , 01.06.2012

Abstract

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.

References

  • Almquist A, Goldenberg IF, and Milstein S. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med. 1989 Feb 9;320(6):346-51.
  • Kapoor WN. Syncope. In: Rosendorff C, ed. Essential Cardiology: Principles and Practice. Philedelphia, Pennsylvania: WB Saunders Co, 2001; Chapter 18: 332-44
  • Benditt DG, Ferguson DW, Grubb BP. ACC Expert Consensus Document.: Tilt table testing for assessing syncope. J Am Coll Cardiol 1996; 28:263- 75
  • Milstein S, Buetikofer J, Lesser J, et al. Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia. J Am Coll Cardiol 1989;14:1626-32.
  • Grubb BP, Temesy-Armos P, Moore J. Head-upright tilt-table testing in evaluation and management of the malignant vasovagal syndrome. Am J Cardiol. 1992 Apr 1;69(9):904-8
  • Brignole M, Menozzi C, Gianfranchi L et al. The clinical and prognostic significance of the asystolic response during the head-up tilt test. Eur J Cardiac Pacing Electrophysiol 1992;2:109-13.
  • Dhala A, Natale A, Sra J. Relevance of asystole during head-up tilt testing. Am J Cardiol 1995;75:251-4.
  • Van Dijk N, Velzeboer SC, Destrée-Vonk A, et al. Psychological treatment of malignant vasovagal syncope due to bloodphobia. Pacing Clin Electrophysiol 2001;24:122-4.
  • Maloney JD, Jaeger FJ, Fouad-Tarazi FM. Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt. Case report and review of diagnosis, pathophysiology, and therapy. Cleve Clin J Med 1988;55:542-8.
  • 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;23:483-9.
  • Sucu M, Sari I, Davutoglu V. A case of prolonged asystole during head-up tilt testing. Turk Kardiyol Dern Ars. 2009 Jul;37(5):345-7.
  • Leftheriotis DI, Theodorakis GN, Kremastinos DT et al. Prolonged asystole during head-up tilt testing with clomipramine infusion. Europace 2003;5:313-5.
  • 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;84:509-14.
  • Benditt DG, Petersen M, Lurie KG, et al. Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Intern Med 1995;122:204-9.
  • Benditt DG, Sutton R, Gammage M, et al. “Rate-drop response” cardiac pacing for vasovagal syncope. Rate-Drop Response Investigators Group. J Interv Card Electrophysiol 1999; 3:27-33.
  • Petersen ME, Chamberlain-Webber R, Fitzpatrick AP, et al. Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br Heart J 1994;71:274-81.
  • Ammirati F, Colivicchi F, Santini M, et al; Syncope Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001;104:52-7. Study

Tilt Testi Sırasında Aşırı Uzamış Asistol

Year 2012, Volume: 2 Issue: 2, - , 01.06.2012

Abstract

Tilt testi nörokardiyojenik senkoplu hastalarda kullanılan bir yöntemdir. 31 yaşında kadın hasta, son iki aydır bulantı ve terlemeyi takiben ortaya çıkan üç senkop atağı nedeniyle kardiyolojik açıdan incelendi. Hastanın elektrokardiyografi ve ekokardiyografi de dahil tüm sistem incelemeleri normal bulundu. Bunun üzerine, hastaya eğimi 60 dereceye ayarlanan tilt testi uygulandı. Testin yaklaşık 8. dakikasında hastada bradikardi ve asistolün eşlik ettiği senkop gelişti. Hipotansiyonla birlikte 20 saniye süren ventriküler asistol ve bilinç kaybı görülmesi üzerine hasta sırtüstü pozisyonda yatırıldı ve kalp mesajına başlandı. Yaklaşık 20 saniye sonra hasta yavaş yavaş sinüs ritmine döndü ve ardından bilinci yerine geldi. Tedavi olarak hastaya iki odacıklı kalp pili takıldı. Bir yıllık izlemi içinde hastanın semptomlarında herhangi bir tekrarlama olmadı

References

  • Almquist A, Goldenberg IF, and Milstein S. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med. 1989 Feb 9;320(6):346-51.
  • Kapoor WN. Syncope. In: Rosendorff C, ed. Essential Cardiology: Principles and Practice. Philedelphia, Pennsylvania: WB Saunders Co, 2001; Chapter 18: 332-44
  • Benditt DG, Ferguson DW, Grubb BP. ACC Expert Consensus Document.: Tilt table testing for assessing syncope. J Am Coll Cardiol 1996; 28:263- 75
  • Milstein S, Buetikofer J, Lesser J, et al. Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia. J Am Coll Cardiol 1989;14:1626-32.
  • Grubb BP, Temesy-Armos P, Moore J. Head-upright tilt-table testing in evaluation and management of the malignant vasovagal syndrome. Am J Cardiol. 1992 Apr 1;69(9):904-8
  • Brignole M, Menozzi C, Gianfranchi L et al. The clinical and prognostic significance of the asystolic response during the head-up tilt test. Eur J Cardiac Pacing Electrophysiol 1992;2:109-13.
  • Dhala A, Natale A, Sra J. Relevance of asystole during head-up tilt testing. Am J Cardiol 1995;75:251-4.
  • Van Dijk N, Velzeboer SC, Destrée-Vonk A, et al. Psychological treatment of malignant vasovagal syncope due to bloodphobia. Pacing Clin Electrophysiol 2001;24:122-4.
  • Maloney JD, Jaeger FJ, Fouad-Tarazi FM. Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt. Case report and review of diagnosis, pathophysiology, and therapy. Cleve Clin J Med 1988;55:542-8.
  • 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;23:483-9.
  • Sucu M, Sari I, Davutoglu V. A case of prolonged asystole during head-up tilt testing. Turk Kardiyol Dern Ars. 2009 Jul;37(5):345-7.
  • Leftheriotis DI, Theodorakis GN, Kremastinos DT et al. Prolonged asystole during head-up tilt testing with clomipramine infusion. Europace 2003;5:313-5.
  • 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;84:509-14.
  • Benditt DG, Petersen M, Lurie KG, et al. Cardiac pacing for prevention of recurrent vasovagal syncope. Ann Intern Med 1995;122:204-9.
  • Benditt DG, Sutton R, Gammage M, et al. “Rate-drop response” cardiac pacing for vasovagal syncope. Rate-Drop Response Investigators Group. J Interv Card Electrophysiol 1999; 3:27-33.
  • Petersen ME, Chamberlain-Webber R, Fitzpatrick AP, et al. Permanent pacing for cardioinhibitory malignant vasovagal syndrome. Br Heart J 1994;71:274-81.
  • Ammirati F, Colivicchi F, Santini M, et al; Syncope Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001;104:52-7. Study
There are 18 citations in total.

Details

Primary Language Turkish
Journal Section Case Report
Authors

Orhan Dogdu This is me

Mehmet Tugrul Inanc This is me

Mikail Yarlıoglues This is me

Mehmet Gungor Kaya This is me

Publication Date June 1, 2012
Published in Issue Year 2012 Volume: 2 Issue: 2

Cite

APA Dogdu, O., Inanc, M. T., Yarlıoglues, M., Kaya, M. G. (2012). Tilt Testi Sırasında Aşırı Uzamış Asistol. Çağdaş Tıp Dergisi, 2(2).
AMA Dogdu O, Inanc MT, Yarlıoglues M, Kaya MG. Tilt Testi Sırasında Aşırı Uzamış Asistol. J Contemp Med. June 2012;2(2).
Chicago Dogdu, Orhan, Mehmet Tugrul Inanc, Mikail Yarlıoglues, and Mehmet Gungor Kaya. “Tilt Testi Sırasında Aşırı Uzamış Asistol”. Çağdaş Tıp Dergisi 2, no. 2 (June 2012).
EndNote Dogdu O, Inanc MT, Yarlıoglues M, Kaya MG (June 1, 2012) Tilt Testi Sırasında Aşırı Uzamış Asistol. Çağdaş Tıp Dergisi 2 2
IEEE O. Dogdu, M. T. Inanc, M. Yarlıoglues, and M. G. Kaya, “Tilt Testi Sırasında Aşırı Uzamış Asistol”, J Contemp Med, vol. 2, no. 2, 2012.
ISNAD Dogdu, Orhan et al. “Tilt Testi Sırasında Aşırı Uzamış Asistol”. Çağdaş Tıp Dergisi 2/2 (June 2012).
JAMA Dogdu O, Inanc MT, Yarlıoglues M, Kaya MG. Tilt Testi Sırasında Aşırı Uzamış Asistol. J Contemp Med. 2012;2.
MLA Dogdu, Orhan et al. “Tilt Testi Sırasında Aşırı Uzamış Asistol”. Çağdaş Tıp Dergisi, vol. 2, no. 2, 2012.
Vancouver Dogdu O, Inanc MT, Yarlıoglues M, Kaya MG. Tilt Testi Sırasında Aşırı Uzamış Asistol. J Contemp Med. 2012;2(2).