title: Sublingual isosorbide dinitrate-stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents.
abstract: Vasovagal syncope is the most likely cause of syncope in the young. Head-up tilt-table test (HUT) provides the ability to provoke vasovagal syncope under controlled laboratory settings. In adult populations, pharmacologic stimulation with intravenous/sublingual isosorbide dinitrate (ISDN) has been shown to be an alternative to isoproterenol for increasing the diagnostic yield of HUT. In this study, 40 patients aged 9-18 years with unexplained syncope and 12 healthy age-matched children were evaluated by HUT to 70 degrees for 45 minutes. If tilting alone did not induce symptoms (syncope and presyncope), 0.1 mg/kg ISDN was given while the patient lay supine. After 5 min, the table was tilted to 70 degrees for 15 min or until the symptoms occurred. The control group consisted of 12 healthy age-matched children studied in a similar manner. Six patients (15%) had a positive basal tilt test. Twenty-five patients (62.5%) lost consciousness following ISDN administration. In the control group, nobody had a syncopal episode during the basal tilt test. However, ISDN administration resulted in 1 positive response (8.3%). The sensitivity of the test was 77.5% and its specificity was 91.6%. It is concluded that sublingual nitroglycerin HUT is suitable for routine clinical practice in children and adolescents with unexplained syncope.
authors.affiliation: Department of Pediatric Cardiology, Istanbul Faculty of Medicine, University of Istanbul, Millet Cd. Capa, 34390 Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Dindar
authors.forename: B
authors.initials: B
authors.lastname: Cetin
authors.forename: T
authors.initials: T
authors.lastname: Ertuğrul
authors.forename: T
authors.initials: T
authors.lastname: Cantez
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000503:physiopathology; D007548:Isosorbide Dinitrate / Q000008:administration & dosage; D008297:Male; D011187:Posture / Q000502:physiology; D012680:Sensitivity and Specificity; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000503:physiopathology; D018667:Tilt-Table Test / Q000379:methods*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate