Age and Ageing, Vol 29, 419-424, Copyright © 2000 by British Geriatrics Society
N Kumar, J Youde, C Ruse, M Fotherby and T Masud
Background. Prolonged head-up tilt testing and
sublingual nitrate provocation are increasingly used in the diagnosis of
neurocardiogenic syncope. However there are few data regarding the results
of these tests in asymptomatic older subjects.Objective.
To assess the responses to the prolonged head-up tilt test
followed by sublingual glyceryl trinitrate provocation in asymptomatic
subjects over the age of 60 years.Design.
Observational study.Method. We recruited 64
asymptomatic subjects over the age of 60 (39 men, 25 women) from two
general practice lists in Nottingham and Leicester. Exclusion criteria
were: history of syncope, ischaemic heart disease, cerebrovascular disease,
marked aortic stenosis, carotid artery disease and being unable to stand
for the duration of the test. All subjects underwent a full clinical
examination, a 12-lead electrocardiogram and a 30-40-min head-up if the
subjects developed syncope or symptoms or presyncope associated with
hypotension with or without bradycardia. If they remained asymptomatic at
the end of this period, they received 400
ARTICLES
Responses to the prolonged head-up tilt followed by sublingual nitrate provocation in asymptomatic older adults
Nottingham City Hospital NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK; The Glenfield Hospital, Leicester, UK; Corresponding author Fax: +44 115 960 8409; E-mail: tm@nchhce.demon.co.uk
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of sublingual glyceryl trinitrate and monitoring continued for another 15
min.Settings. Two teaching hospital in Nottingham and
Leicester.Results. Six (9%) of the subjects had a
positive response (syncope or presyncope) to the prolonged head-up tilt
test prior to glyceryl trinitrate provocation. After provocation, 30 (52%)
of the remaining 58 subjects had a positive response.Conclusion.
The role of sublingual glyceryl trinitrate provocation following
prolonged head-up tilt testing in the diagnosis of neurocardiogenic
(vasovagal) syncope in older people is questionable, as many asymptomatic
older subjects demonstrate syncopal or presyncopal
symptoms.Keywords: neurocardiogenic, nitrates,
provocation, syncope, vasovagal
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  S. W. Parry, J. C. Gray, J. L. Newton, P. Reeve, D. O'shea, and R. A. Kenny 'Front-loaded' head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope Age Ageing, July 1, 2008; 37(4): 411 - 415. [Abstract] [Full Text] [PDF]
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