Usefulness of head-up tilt test in the evaluation and management of unexplained syncope or pre-syncope

B R Fang, L T Kuo
Japanese Heart Journal 2000, 41 (5): 623-31
This study included 87 consecutive patients with unexplained syncope or pre-syncope who had undergone the head-up tilt (HUT) test with concomitant isoproterenol infusion. A positive response was defined as development of syncope or pre-syncope in association with substantial hypotension (decline of systolic blood pressure > or = 20 mmHg). Coronary artery spasm was suggested from the clinical symptoms and electrocardiographic findings in 1 patient (1/87= 1.1%). Intolerance to isoproterenol infusion was noted in 8 cases (8/87 = 9%). Of the 78 patients who completed the study, 73 showed positive responses (73/78 = 94%). (baseline systolic blood pressure = 125 +/- 23 mmHg endpoint systolic blood pressure = 76 +/- 11 mmHg, p < 0.05; baseline heart rate = 73 +/- 14 beats per minute vs endpoint HR = 80 +/- 24 beats per minute, p < 0.05). In 73 patients who showed positive responses, the systolic blood pressure (SBP) and heart rate (HR) returned to a safe level at 2 minutes when the patients were returned to a supine position (post-study 2 minutes SBP = 124 +/- 18 mmHg vs baseline SBP 125 +/- 23 mmHg, p = NS; post-study 2 minutes HR = 82 +/- 18 beats per minute vs baseline HR = 73 +/- 14 beats per minute, p < 0.05). All 73 patients with a positive HUT test received Atenolol therapy (50 mg daily). Only 35 of these 73 patients took Atenolol regularly and had a repeat HUT test. After atenolol therapy, persistent positive responses were observed in 19 cases (19/35 = 54%) and negative responses were noted in 16 cases (16/35 = 46%). The mean dosage of isoproterenol needed to provoke a positive HUT test in 19 patients who had received Atenolol therapy and had a positive repeat HUT test was 2.3 +/- 1.2 microg/min at baseline and 3.5 +/- 0.9 microg/min for post-Atenolol therapy (p < 0.001). Sixteen patients with a negative repeat HUT test were treated continuously with Atenolol and followed for a mean period of 13 +/- 11 months (range, 1-34 months). All 16 patients were free of syncope or pre-syncope during the period of follow up. In conclusion, the HUT test is mostly well tolerated and safe, even though the test has a low rate of adverse effects. Atenolol is effective for the prevention of provoked or spontaneous recurrent syncope or pre-syncope.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"