title: Recurrent unexplained syncope in the elderly: the use of head-upright tilt table testing in evaluation and management.
abstract: OBJECTIVE
  To investigate the usefulness of head-upright tilt table testing for vasovagal episodes in the evaluation and management of elderly patients with recurrent idiopathic syncope.
  
  
  METHODS
  Prospective survey.
  
  
  METHODS
  Electrophysiology laboratory of a university hospital.
  
  
  METHODS
  Twenty-five patients (11 male, 14 female; mean age 73 +/- 6 years) with recurrent unexplained syncope and seven control subjects with other causes of syncope (4 male, 3 female; mean age 70 +/- 4 years).
  
  
  METHODS
  Each patient underwent head-upright tilt table testing for 30 minutes with or without an infusion of isoproterenol (1-3 micrograms/min given intravenously) in an attempt to provoke bradycardia, hypotension, or both.
  
  
  RESULTS
  Syncope occurred in nine patients (36%) during the baseline tilt and in seven patients (28%) during isoproterenol infusion (total positives 64%). None of the controls had syncope during the test. All of the patients who had positive test results eventually became tilt table negative with therapy, and over a mean follow-up period of 24 months, no further syncopal episodes have occurred.
  
  
  CONCLUSIONS
  Head-upright tilt table testing combined with isoproterenol infusion may be a useful tool in the diagnosis of vasovagal syncope in the elderly and in the evaluation of preventive therapy.
authors.affiliation: Department of Medicine, Medical College of Ohio, Toledo 43699.
authors.forename: B P
authors.initials: BP
authors.lastname: Grubb
authors.forename: D
authors.initials: D
authors.lastname: Wolfe
authors.forename: D
authors.initials: D
authors.lastname: Samoil
authors.forename: E
authors.initials: E
authors.lastname: Madu
authors.forename: P
authors.initials: P
authors.lastname: Temesy-Armos
authors.forename: H
authors.initials: H
authors.lastname: Hahn
authors.forename: L
authors.initials: L
authors.lastname: Elliott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use; D001513:Beds / Q000592:standards*; D001794:Blood Pressure; D004206:Disopyramide / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006257:Head; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008991:Monitoring, Physiologic; D011187:Posture; D011446:Prospective Studies; D012008:Recurrence; D012601:Scopolamine / Q000008:administration & dosage / Q000627:therapeutic use; D013575:Syncope / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D001262:Atenolol; D012601:Scopolamine; D004206:Disopyramide; D007545:Isoproterenol