Serious response during tilt-table test in elderly and its prophylactic management.
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.
Han
Yang
Y
First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China. Hanyang1088@hotmail.com
Li
Xiao-xia
XX
Jiang
Wei-li
WL
Wang
Zhao-di
ZD
Chen
Tian-zhi
TZ
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*