P-260 A negative tilt-table test can be predicted by measuring early heart rate changes during the first 10 minutes of the test in patients with a history of syncope

Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous autonomic disorder characterised by orthostatic intolerance and a rise in heart rate by at least 30 bpm or an absolute heart rate value of at least 120 bpm within 10 min of standing or during a tilt table test. Overwhelmingly, POTS affects young Caucasian women, which can lead physicians to miss the diagnosis in men or non-white patients. We describe a case of 29-year-old African-American man who developed lightheadedness, generalised weakness, tachycardia and palpitations and was subsequently diagnosed with POTS. We review its clinical features, differential diagnosis, pathophysiology and treatment options. We also emphasise that POTS should be considered as a differential diagnosis in any patient presenting with typical clinical features, who may not be in the usual demographics of the disorder.

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The Diagnostic Value of Cardiac Deceleration Capacity in Vasovagal Syncope

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.008659 ◽

2020 ◽

Vol 13 (12) ◽

Author(s):

Lihui Zheng ◽

Wei Sun ◽

Shangyu Liu ◽

Erpeng Liang ◽

Zhongpeng Du ◽

...

Keyword(s):

Heart Rate ◽

Vasovagal Syncope ◽

Diagnostic Value ◽

Control Group ◽

Vagal Activity ◽

Tilt Table Test ◽

Tilt Table ◽

Good Tool ◽

Deceleration Capacity ◽

Vagal Control

Background: Increased parasympathetic activity is thought to play important roles in syncope events of patients with vasovagal syncope (VVS). However, direct measurements of the vagal control are difficult. The novel deceleration capacity (DC) of heart rate measure has been used to characterize the vagal modulation. This study aimed to assess vagal control in patients with VVS and evaluate the diagnostic value of the DC in VVS. Methods: Altogether, 161 consecutive patients with VVS (43±15 years; 62 males) were enrolled. Tilt table test was positive in 101 and negative in 60 patients. Sixty-five healthy subjects were enrolled as controls. DC and heart rate variability in 24-hour ECG, echocardiogram, and biochemical examinations were compared between the syncope and control groups. Results: DC was significantly higher in the syncope group than in the control group (9.6±3.3 versus 6.5±2.0 ms, P <0.001). DC was similarly increased in patients with VVS with a positive and negative tilt table test (9.7±3.5 and 9.4±2.9 ms, P =0.614). In multivariable logistic regression analyses, DC was independently associated with syncope (odds ratio=1.518 [95% CI, 1.301–1.770]; P =0.0001). For the prediction of syncope, the area under curve analysis showed similar values when comparing single DC and combined DC with other risk factors ( P =0.1147). From the receiver operator characteristic curves for syncope discrimination, the optimal cutoff value for the DC was 7.12 ms. Conclusions: DC>7.5 ms may serve as a good tool to monitor cardiac vagal activity and discriminate VVS, particularly in those with negative tilt table test.

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P6573Adenosine plasma levels may determine tilt table test outcome in syncopal patients with prodromal symptoms

European Heart Journal ◽

10.1093/eurheartj/ehz746.1161 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Sotiriadou ◽

A Antoniadis ◽

S Vergopoulos ◽

C Lazaridis ◽

P Konstantinidis ◽

...

Keyword(s):

Risk Stratification ◽

Supine Position ◽

Plasma Levels ◽

Structural Heart Disease ◽

The Body ◽

Diagnostic Workup ◽

Tilt Table Test ◽

Tilt Table ◽

Prodromal Symptoms ◽

History Of

Abstract Background/Introduction Head-up tilt table test (HUTT) and Adenosine test (ADT) are tools frequently used in the diagnostic workup of syncope. It has been suggested that patient responses to HUTT and ADT can be related to the plasma levels of Adenosine (ADPL) and Adenosine receptors (ADR). However, the exact type of association and the role of (ADPL) and ADR levels in the risk stratification and management of patients with syncope has not yet been clarified. Purpose We sought to assess the ADPL and ADR levels in patients without structural heart disease who underwent HUTT and ADT tests as part of the diagnostic workup of syncope. We specifically investigated differences with regards to the presence of a history of prodromal symptoms. Methods HUTT and ADT were performed as per the standard protocols. ADT was considered positive in the event of asystole >6 seconds or heart block for >10 seconds after intravenous Adenosine administration in a supine position at a dose of 0.15 mg/kg. ADPL were assessed at three timepoints during the HUTT: in the supine position, immediately after bed tilt and, in cases of a positive test, at the time of syncope. Furthermore, we assessed the A2A ADR of monocytes in the study patients. Results We prospectively analyzed 77 patients (48 women, age 47.05±21.10 years). ADT was positive in 16.7% of patients and HUTT in 49.4% of patients. ADPL in the supine position did not differ between patients with negative vs. positive ADT but showed a significant correlation with the body mass index (p=0.002). There was a trend for reduced ADPL at the tilt phase in patients with positive HUTT (0.32±0.89 vs. 0.42±0.77 ppm/Um/L, p=0.09). Of all patients, 60 (77.9%, 41 women, age 46.80±21.83 years) had reported a history of prodromal symptoms at syncope. In the subset of patients with prodromal symptoms, the ADL at the tilt phase were lower in patients with positive vs. negative HUTT (0.15±0.23 vs. 0.51±0.89, p<0.05). ADR did not differ among groups but showed a significant correlation with the ADL during syncope in patients with prodromal symptoms (p<0.05). Conclusion(s) Patients with prodromal symptoms and a positive HUTT demonstrate reduced ADPL at the tilt phase of HUTT preceding syncope. In these patients, ADPL in syncope correlate with the ADR. Adenosine plasma levels and receptors warrant further investigation and may predict the response to HUTT thereby contributing to the diagnostic evaluation and risk stratification of patients with syncope.

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Cardiorespiratory Regulation in Migraine. Results in Children and Adolescents and Review of the Literature

Cephalalgia ◽

10.1111/j.1468-2982.2005.01039.x ◽

2006 ◽

Vol 26 (3) ◽

pp. 295-309 ◽

Cited By ~ 7

Author(s):

F Ebinger ◽

M Kruse ◽

U Just ◽

D Rating

Keyword(s):

Heart Rate ◽

Children And Adolescents ◽

Learned Helplessness ◽

Valsalva Manoeuvre ◽

Tilt Table Test ◽

Review Of The Literature ◽

Tilt Table ◽

Passive Coping ◽

Cardiorespiratory Function ◽

Autonomic Tests

To investigate autonomic regulation in juvenile migraine we studied 70 children and adolescents with migraine during the headache-free period and 81 healthy controls by cardiorespiratory function tests. Heart rate variability was analysed with time and frequency domain indices during spontaneous breathing at rest and during metronomic breathing. Changes of heart rate and blood pressure were studied during tilt-table test, active standing, Valsalva manoeuvre and sustained handgrip. We found significant differences in metronomic breathing, tilt-table test and Valsalva manoeuvre. We interpret our findings and results reported in the literature as pointing to a restricted ability of the system to rest, which supports therapies intending to further this ability. In autonomic tests, hyperreactivity in juvenile migraineurs changes to hyporeactivity and passive coping in adults. This might be explained by disturbances of raphe nuclei and the periaqueductal grey. It corresponds to psychological findings in juvenile migraineurs reporting hypersensitivity and repressed aggression and claiming learned helplessness.

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Effects Of Race On Heart Rate Variability In Young Normotensives During Tilt-table Test

Medicine & Science in Sports & Exercise ◽

10.1097/00005768-200505001-02217 ◽

2005 ◽

Vol 37 (Supplement) ◽

pp. S426

Author(s):

Tatiana Warren ◽

Scott Collier ◽

Erin Kelly ◽

Steve Capella ◽

Shannon Byrne ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Tilt Table Test ◽

Tilt Table

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Wavelet analysis of nonstationary heart rate variability in a head-up tilt-table test

BIOPHYSICS ◽

10.1134/s0006350912040033 ◽

2012 ◽

Vol 57 (4) ◽

pp. 530-543 ◽

Cited By ~ 4

Author(s):

S. V. Bozhokin ◽

E. M. Lesova ◽

V. O. Samoilov ◽

P. I. Tolkachev

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Wavelet Analysis ◽

Tilt Table Test ◽

Tilt Table ◽

Head Up Tilt

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Parameters of Heart Rate Variability Can Predict Prolonged Asystole before Head-Up Tilt Table Test

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12149 ◽

2014 ◽

Vol 19 (5) ◽

pp. 477-482 ◽

Cited By ~ 3

Author(s):

Erdal Gursul ◽

Serdar Bayata ◽

Selcen Yakar Tuluce ◽

Rida Berilgen ◽

Ozgen Safak ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Tilt Table Test ◽

Tilt Table ◽

Head Up Tilt ◽

Prolonged Asystole

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Assessment of Quadratic Nonlinear Cardiorespiratory Couplings During Tilt Table Test by Means of Real Wavelet Biphase

Jornada de Jóvenes Investigadores del I3A ◽

10.26754/jji-i3a.201711972 ◽

2017 ◽

Vol 5 ◽

Author(s):

Spyridon Kontaxis ◽

Jesús Lázaro ◽

Eduardo Gil ◽

Pablo Laguna ◽

Raquel Bailón

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Nervous System ◽

Autonomic Nervous System ◽

Tilt Table Test ◽

Phase Coupling ◽

Tilt Table ◽

Autonomic Nervous ◽

Quadratic Phase Coupling ◽

Quadratic Phase

In this paper a method for the assessment of Quadratic Phase Coupling (QPC) between respiration and Heart Rate Variability is presented and applied to study cardiorespiratory couplings during a tilt table test. Strong QPC related to the dominant respiratory frequency is present and remains unchanged during Autonomic Nervous System changes.

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