title: Serious response during tilt-table test in elderly and its prophylactic management.
abstract: OBJECTIVE
  To evaluate the serious response during tilt-table test (TTT) and its prophylactic management.
  
  
  METHODS
  Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct.
  
  
  RESULTS
  Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II degrees -I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications.
  
  
  CONCLUSIONS
  Although non-invasive, TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.
authors.affiliation: First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China. Hanyang1088@hotmail.com
authors.forename: Yang
authors.initials: Y
authors.lastname: Han
authors.forename: Xiao-xia
authors.initials: XX
authors.lastname: Li
authors.forename: Wei-li
authors.initials: WL
authors.lastname: Jiang
authors.forename: Zhao-di
authors.initials: ZD
authors.lastname: Wang
authors.forename: Tian-zhi
authors.initials: TZ
authors.lastname: Chen
mesh_terms: D000368:Aged; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D018579:Patient Selection; D013575:Syncope / Q000209:etiology / Q000517:prevention & control; D018667:Tilt-Table Test / Q000009:adverse effects*