title: Pharmacological washout for the correct evaluation of the head-up tilt testing.
abstract: Head-up tilt testing is an important tool in the diagnosis of syncope. Several different protocols are in use. We describe the case of a 70-year-old Italian woman admitted to our observation. The patient was in antihypertensive treatment with carvedilol and with a combination of lisinopril and hydrochlorothiazide. A simplified Italian protocol head-up tilt testing was performed. A 4.10 s pause with syncope and a profound hypotension (blood pressure values were 65/50 mm Hg) were observed after 3 min in the provocation phase. Second-degree atrioventricular Block of the 2:1 form, advanced second-degree atrioventricular block and junctional escape rhythm (28 bpm) were observed. A simplified Italian protocol head-up tilt testing was performed after 40 days of withdrawal of carvedilol. A 2 s pause with presyncope and a hypotension (blood pressure values were 80/70 mm Hg) were observed after 2 min in the provocation phase. ECG revealed a bradycardic sinusal rhythm with heart rate of 42 bpm. This case assesses the importance of a pharmacological washout for the correct evaluation of the head-up tilt testing.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pugliatti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Patanè
authors.forename: Antonino
authors.initials: A
authors.lastname: Recupero
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Coglitore
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000493:pharmacokinetics*; D002227:Carbazoles / Q000493:pharmacokinetics*; D000077261:Carvedilol; D003951:Diagnostic Errors / Q000517:prevention & control; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000493:pharmacokinetics; D006973:Hypertension / Q000188:drug therapy*; D007024:Hypotension, Orthostatic / Q000209:etiology; D017706:Lisinopril / Q000493:pharmacokinetics; D011412:Propanolamines / Q000493:pharmacokinetics*; D013575:Syncope / Q000175:diagnosis*; D018667:Tilt-Table Test
chemical_list: D000959:Antihypertensive Agents; D002227:Carbazoles; D011412:Propanolamines; D006852:Hydrochlorothiazide; D000077261:Carvedilol; D017706:Lisinopril