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Isosorbide dinitrate spray stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents Original Article

Year 2009, Volume: 44 Issue: 3, 94 - 98, 01.09.2009

Abstract

Aim: Vasovagal syncope neurocardiogenic is the most common cause of syncope in childhood It is generally more common among adolescent girls and rare before the age of 10 years Head up tilt table test provides the ability to provoke vasovagal test and helps to document the type of response by cardiac rhythm and blood pressure monitorization If basal tilt test is negative pharmacologic stimulation with isoproterenol or isosorbide dinitrate ISDN administiration may increase the sensitivity of the test Material and Method: In this study 88 patients aged 9 18 years having repeated unexplored syncope were evaluated by tilt test at 70° for 30 minutes The patients who did not develop syncope by this test were given 400 micrograms of ISDN spray sublingually and were kept under close monitoring until the findings were seen or if not for 15 minutes Results: Twentyfour patients 37 had a positive basal tilt test Forty patients 46 had syncope following ISDN administiration No side effect related to ISDN administirastion was observed The types of positive responses were mixed type in 37 patients 58 cardioinhibitory without asystole in six patients 9 cardioinhibitory with asystole in seven patients 11 and vasodepressor types in 14 patients 22 respectively Conclusions: This study concludes that pharmacological stimulation with sublingual ISDN is safe and easy to perform in children considered to have vasovagal syncope clinically and helps to increase the diagnostic value of tilt testing Turk Arch Ped 2009; 44: 94 8 Key words: Isosorbide dinitrate spray tilt test vasovagal syncope

References

  • McLeod KA. Syncope in childhood. Arch Dis Child 2003; 88: 350-3. (Abstract) / (Full Text) / (PDF) 2. Müller G, Deal BJ, Strasburger JF, Benson DW Jr. Usefulness of metoprolol for unexplained syncope and positive response to tilt testing in young persons. Am J Cardiol 1993; 40: 111-4. (Abstract) 3. Ruckman RN. Cardiac causes of syncope. Pediatr Rev 1987; 9: 101-9. (Abstract) / (PDF)
  • Tanel RE, Walsh EP. Syncope in the pediatric patient. Cardiol Clin 1997; 15: 277-94. (Abstract)
  • Vlahos AP, Tzoufi M, Katsouras CS, et al. Provocation of neuro- cardiogenic syncope during head-up tilt testing in children: comparison between isoproterenol and nitroglycerin. Pediatrics 2007; 119: 419-25. (Abstract) / (Full Text) / (PDF)
  • Pongiglione G, Fish FA, Strasburger JF, Benson DW. Heart rate and blood pressure response to upright tilt in young patients with unexplained syncope. J Am Coll Cardiol 1990; 16: 165-70. (Abstract)
  • Thilenius OG, Quinones JA, Husayni TS, Novak J. Tilt test for di- agnosis of unexplained syncope in pediatric patients. Pediatrics 1991; 87: 334-8. (Abstract) / (PDF)
  • Aerts A, Dendale P, Strobel G, Block P. Sublingual nitrates du- ring head-up tilt testing for the diagnosis of vasovagal syncope. Am Heart J 1997; 133: 504-7. (Abstract) / (Full Text) / (PDF)
  • Grubb BP, Temesy-Armos P, Moore J, Wolfe D, Hahn H, Elliott L. The use of head-upright tilt table testing in the evaluation and management of syncope in children and adolescents. Pacing Clin Electrophysiol 1992; 15: 742-8. (Abstract)
  • Sheldon R, Killam S. Methodology of isoproterenol tilt table tes- ting in patients with syncope. J Am Coll Cardiol 1992; 19: 773-9. (Abstract)
  • Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evalua- ting syncope: a comprehensive literature review. Am J Med 1994; 97: 78-88. (Abstract)
  • Oraii S, Maleki M, Minooii M, Kafaii P. Comparing two different protocols for tilt table testing: sublingual glyceryl trinitrate versus isoprenaline infusion. Heart 1999; 81: 603-5. (Abstract) / (PDF)
  • Raviele A, Giada F, Brignole M, et al. Comparison of diagnostic accuracy of sublingual nitroglycerin test and low-dose isoprote- renol test in patients with unexplained syncope. Am J Cardiol 2000; 85: 1194-8. (Abstract)
  • Dindar A, Cetin B, Ertuğrul T, Cantez T. Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents. Pediatr Cardiol 2003; 24: 270-3. (Abstract) / (PDF)
  • Brignole M, Alboni P, Benditt DG, et al. Task force on syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 2004; 6: 467-537. (Abstract) / (Full Text) / (PDF)
  • Qingyou Z, Junbao D, Jianjun C, Wanzhen L. Association of clini- cal characteristics of unexplained syncope with the outcome of head-up tilt tests in children. Pediatr Cardiol 2004; 25: 360-4. (Abstract) / (Full Text) / (PDF)
  • Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 1039-45. (Abstract)
  • Thilenius OG, Quinoses JA, Husayni TS, Novak J. Tilt test for di- agnosis of unexplained syncope in pediatric patients. Pediatrics 1991; 87: 334-8. (Abstract) / (PDF)
  • Raviele A, Gasparini G, Di Pede F, et al. Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J 1994; 127: 103-11. (Abstract)
  • Raviele A, Menozzi C, Brignole M, et al. Value of head-up tilt tes- ting potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995; 76: 267-72. (Abstract)

Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma

Year 2009, Volume: 44 Issue: 3, 94 - 98, 01.09.2009

Abstract

Amaç: Vazovagal senkop nörokardiyojenik çocukluk çağında görülen senkopların en sık nedenidir Genellikle ergen kızlarda daha sıktır ve 10 yaşından önce görülmesi ise nadirdir “Tilt” testi ortostatik stres oluşturarak hastaların yakınmalarını ortaya çıkarır ve kalp ritminin yakından izlenmesi ile birlikte senkop tipini belirlemede yardımcı olur “Tilt” testi tek başına negatif olanlarda izoproterenol veya izosorbid dinitrat İSDN gibi farmakolojik maddelerle testin duyarlılığı artırılabilir Gereç ve Yöntem: Bu çalışmada yaşları 9 18 yıl arasında değişen ve tekrarlayıcı özellikte açıklanamayan senkop yakınması ile gelen 88 hasta “tilt” testi 70°’de 30 dakika süreli ile değerlendirildi Bu “tilt” testi ile senkop gelişmeyen hastalara dilaltı 400 mikrogram dozunda İSDN sprey uygulandı ve bulgular gelişene kadar ya da 15 dakika boyunca yakın izleme alındı Bulgular: Hastaların 24’ünde 27 ilaçsız ve ISDN sprey ile uyarılmış “tilt” testi ile senkop oluşmazken 24 27 hastada ilaçsız “tilt” testiyle 40 46 hastada ise İSDN uyarısıyla senkop gelişti Senkop gelişen 64 hastanın 24’ünde 37 ilaçsız “tilt” testiyle 40’ında 63 ise İSDN sprey ile uyarılmış “tilt” testiyle senkop gelişti İzosorbid dinitrat sprey uygulanan hastalarda yan etki gözlenmedi Vazovagal senkop gelişen olguların 37’si 58 miks tip altısı 9 asistolisiz kardiyoinhibitör tip yedisi 11 asistolili kardiyoinhibitör tip ve 14’ü 22 vazodepresör tipti Çıkarımlar: Bu çalışma vazovagal senkop şüphesi olan çocukların tanısında İSDN spreyle uyarılmış “tilt” testinin güvenli ve kolay olarak uygulanabileceğini ve ilaçsız “tilt” testinin tanısal değerini yükselttiğini göstermektedir Türk Ped Arş 2009; 44: 94 8 Anahtar kelimeler: İzosorbid dinitrat “tilt” testi vazovagal senkop

References

  • McLeod KA. Syncope in childhood. Arch Dis Child 2003; 88: 350-3. (Abstract) / (Full Text) / (PDF) 2. Müller G, Deal BJ, Strasburger JF, Benson DW Jr. Usefulness of metoprolol for unexplained syncope and positive response to tilt testing in young persons. Am J Cardiol 1993; 40: 111-4. (Abstract) 3. Ruckman RN. Cardiac causes of syncope. Pediatr Rev 1987; 9: 101-9. (Abstract) / (PDF)
  • Tanel RE, Walsh EP. Syncope in the pediatric patient. Cardiol Clin 1997; 15: 277-94. (Abstract)
  • Vlahos AP, Tzoufi M, Katsouras CS, et al. Provocation of neuro- cardiogenic syncope during head-up tilt testing in children: comparison between isoproterenol and nitroglycerin. Pediatrics 2007; 119: 419-25. (Abstract) / (Full Text) / (PDF)
  • Pongiglione G, Fish FA, Strasburger JF, Benson DW. Heart rate and blood pressure response to upright tilt in young patients with unexplained syncope. J Am Coll Cardiol 1990; 16: 165-70. (Abstract)
  • Thilenius OG, Quinones JA, Husayni TS, Novak J. Tilt test for di- agnosis of unexplained syncope in pediatric patients. Pediatrics 1991; 87: 334-8. (Abstract) / (PDF)
  • Aerts A, Dendale P, Strobel G, Block P. Sublingual nitrates du- ring head-up tilt testing for the diagnosis of vasovagal syncope. Am Heart J 1997; 133: 504-7. (Abstract) / (Full Text) / (PDF)
  • Grubb BP, Temesy-Armos P, Moore J, Wolfe D, Hahn H, Elliott L. The use of head-upright tilt table testing in the evaluation and management of syncope in children and adolescents. Pacing Clin Electrophysiol 1992; 15: 742-8. (Abstract)
  • Sheldon R, Killam S. Methodology of isoproterenol tilt table tes- ting in patients with syncope. J Am Coll Cardiol 1992; 19: 773-9. (Abstract)
  • Kapoor WN, Smith MA, Miller NL. Upright tilt testing in evalua- ting syncope: a comprehensive literature review. Am J Med 1994; 97: 78-88. (Abstract)
  • Oraii S, Maleki M, Minooii M, Kafaii P. Comparing two different protocols for tilt table testing: sublingual glyceryl trinitrate versus isoprenaline infusion. Heart 1999; 81: 603-5. (Abstract) / (PDF)
  • Raviele A, Giada F, Brignole M, et al. Comparison of diagnostic accuracy of sublingual nitroglycerin test and low-dose isoprote- renol test in patients with unexplained syncope. Am J Cardiol 2000; 85: 1194-8. (Abstract)
  • Dindar A, Cetin B, Ertuğrul T, Cantez T. Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents. Pediatr Cardiol 2003; 24: 270-3. (Abstract) / (PDF)
  • Brignole M, Alboni P, Benditt DG, et al. Task force on syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 2004; 6: 467-537. (Abstract) / (Full Text) / (PDF)
  • Qingyou Z, Junbao D, Jianjun C, Wanzhen L. Association of clini- cal characteristics of unexplained syncope with the outcome of head-up tilt tests in children. Pediatr Cardiol 2004; 25: 360-4. (Abstract) / (Full Text) / (PDF)
  • Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol 1997; 29: 1039-45. (Abstract)
  • Thilenius OG, Quinoses JA, Husayni TS, Novak J. Tilt test for di- agnosis of unexplained syncope in pediatric patients. Pediatrics 1991; 87: 334-8. (Abstract) / (PDF)
  • Raviele A, Gasparini G, Di Pede F, et al. Nitroglycerin infusion during upright tilt: a new test for the diagnosis of vasovagal syncope. Am Heart J 1994; 127: 103-11. (Abstract)
  • Raviele A, Menozzi C, Brignole M, et al. Value of head-up tilt tes- ting potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope. Am J Cardiol 1995; 76: 267-72. (Abstract)
There are 18 citations in total.

Details

Primary Language Turkish
Journal Section Original Article
Authors

Yakup Ergül This is me

Aygün Dindar This is me

Ümrah Aydoğan This is me

Rukiye Eker Eker Ömeroğlu This is me

Türkan Ertuğrul This is me

Publication Date September 1, 2009
Published in Issue Year 2009 Volume: 44 Issue: 3

Cite

APA Ergül, Y., Dindar, A., Aydoğan, Ü., Ömeroğlu, R. E. E., et al. (2009). Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma. Türk Pediatri Arşivi, 44(3), 94-98.
AMA Ergül Y, Dindar A, Aydoğan Ü, Ömeroğlu REE, Ertuğrul T. Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma. Türk Pediatri Arşivi. September 2009;44(3):94-98.
Chicago Ergül, Yakup, Aygün Dindar, Ümrah Aydoğan, Rukiye Eker Eker Ömeroğlu, and Türkan Ertuğrul. “Çocuk Ve Ergenlerde Vazovagal Senkop tanısında Izosorbid Dinitrat Sprey Ile uyarılmış ‘tilt’ Testinin kullanımı Orijinal Araştırma”. Türk Pediatri Arşivi 44, no. 3 (September 2009): 94-98.
EndNote Ergül Y, Dindar A, Aydoğan Ü, Ömeroğlu REE, Ertuğrul T (September 1, 2009) Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma. Türk Pediatri Arşivi 44 3 94–98.
IEEE Y. Ergül, A. Dindar, Ü. Aydoğan, R. E. E. Ömeroğlu, and T. Ertuğrul, “Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış ‘tilt’ testinin kullanımı Orijinal Araştırma”, Türk Pediatri Arşivi, vol. 44, no. 3, pp. 94–98, 2009.
ISNAD Ergül, Yakup et al. “Çocuk Ve Ergenlerde Vazovagal Senkop tanısında Izosorbid Dinitrat Sprey Ile uyarılmış ‘tilt’ Testinin kullanımı Orijinal Araştırma”. Türk Pediatri Arşivi 44/3 (September 2009), 94-98.
JAMA Ergül Y, Dindar A, Aydoğan Ü, Ömeroğlu REE, Ertuğrul T. Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma. Türk Pediatri Arşivi. 2009;44:94–98.
MLA Ergül, Yakup et al. “Çocuk Ve Ergenlerde Vazovagal Senkop tanısında Izosorbid Dinitrat Sprey Ile uyarılmış ‘tilt’ Testinin kullanımı Orijinal Araştırma”. Türk Pediatri Arşivi, vol. 44, no. 3, 2009, pp. 94-98.
Vancouver Ergül Y, Dindar A, Aydoğan Ü, Ömeroğlu REE, Ertuğrul T. Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma. Türk Pediatri Arşivi. 2009;44(3):94-8.