title: Use of head-up tilt testing to determine a possible cause of unexpected cardiac asystole during epidural anesthesia.
abstract: Head-up tilt testing is widely used in the diagnosis of syncope of unknown origin. In this report, head-up tilt testing elucidated the etiology of cardiac asystole of unexpected and sudden onset during orthopedic surgery under epidural anesthesia in a 30-year-old woman. Conventional diagnostic approaches were ineffective. Venous pooling in the lower legs as a result of vasodilation and subsequent vagotony due to epidural anesthesia, a condition mimicking orthostatic stress, is proposed as the mechanism of asystole. Follow-up examinations over 16 months revealed no further syncope and a good clinical course. Head-up tilt testing was useful in determining etiology in this case.
authors.affiliation: Department of Internal Medicine, Self Defense Force Central Hospital, Tokyo, Japan.
authors.forename: B
authors.initials: B
authors.lastname: Takase
authors.forename: T
authors.initials: T
authors.lastname: Goto
authors.forename: T
authors.initials: T
authors.lastname: Nagai
authors.forename: A
authors.initials: A
authors.lastname: Uehata
authors.forename: K
authors.initials: K
authors.lastname: Isojima
authors.forename: S
authors.initials: S
authors.lastname: Ohtomi
authors.forename: S
authors.initials: S
authors.lastname: Ohta
authors.forename: T
authors.initials: T
authors.lastname: Takemoto
authors.forename: A
authors.initials: A
authors.lastname: Kurita
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006339:Heart Rate; D006801:Humans; D009985:Orthopedics; D013575:Syncope / Q000503:physiopathology*; D018667:Tilt-Table Test / Q000379:methods*