Different haemodynamic patterns in head-up tilt test on 400 paediatric cases with unexplained syncope

2014 ◽  
Vol 25 (5) ◽  
pp. 911-917 ◽  
Author(s):  
Yilmaz Yozgat ◽  
Cem Karadeniz ◽  
Rahmi Ozdemir ◽  
Onder Doksoz ◽  
Mehmet Kucuk ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Response Patterns ◽  
Baseline Blood Pressure ◽  
Test Protocol ◽  
Tilt Testing ◽  
Head Up Tilt ◽  
Unexplained Syncope

AbstractObjective: To assess haemodynamic patterns in head-up tilt testing on 400 paediatric cases with unexplained syncope. Methods: Medical records of 520 children who underwent head-up tilt testing in the preceding year were retrospectively evaluated, and 400 children, 264 (66%) girls and 136 (34%) boys, aged 12.6±2.6 years (median 13; range 5–18), with unexplained syncope were enrolled in the study. Age, sex, baseline heart rate, baseline blood pressure, frequency of symptoms, and/or fainting attacks were recorded. The test protocol consisted of 25 minutes of supine resting followed by 20 minutes of 70° upright positioning. Subjects were divided into nine groups according to their differing haemodynamic patterns. Results: There were no statistically significant differences between the groups with regard to age, gender, baseline blood pressure, and frequency of syncope (p>0.05). The response was compatible with orthostatic intolerance in 28 cases (7.0%), postural orthostatic tachycardia syndrome in 24 cases (6.0%), asymptomatic postural orthostatic tachycardia syndrome in 26 cases (6.5%), orthostatic hypotension in seven cases (1.7%), vasovagal syncope in 38 cases (9.5%), and negative in 274 cases (69.2%). Vasovagal syncope response patterns were of type 3 in nine cases (2.2%), type 2A in 10 cases (2.5%), type 2B in two cases (0.5%), and type 1 (mixed) in 17 cases (4.25%). Conclusions: In the 400 paediatric cases with unexplained syncope, nine different haemodynamic response patterns to head-up tilt testing were discerned. Children with orthostatic intolerance syndromes are increasingly referred to hospitals because of difficulty in daily activities. Therefore, there is need for further clinical trials in these patient groups.

scholarly journals Distinct neurohumoral biomarker profiles in children with hemodynamically defined orthostatic intolerance may predict treatment options

2016 ◽  
Vol 310 (3) ◽  
pp. H416-H425 ◽  
Author(s):  
Ashley L. Wagoner ◽  
Hossam A. Shaltout ◽  
John E. Fortunato ◽  
Debra I. Diz
Keyword(s):  
Blood Pressure ◽  
Orthostatic Intolerance ◽  
Treatment Options ◽  
Pressure Control ◽  
Hemodynamic Response ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Compensatory Mechanisms ◽  
Oh Groups ◽  
Arterial Blood ◽  
Head Up Tilt

Studies of adults with orthostatic intolerance (OI) have revealed altered neurohumoral responses to orthostasis, which provide mechanistic insights into the dysregulation of blood pressure control. Similar studies in children with OI providing a thorough neurohumoral profile are lacking. The objective of the present study was to determine the cardiovascular and neurohumoral profile in adolescent subjects presenting with OI. Subjects at 10–18 yr of age were prospectively recruited if they exhibited two or more traditional OI symptoms and were referred for head-up tilt (HUT) testing. Circulating catecholamines, vasopressin, aldosterone, renin, and angiotensins were measured in the supine position and after 15 min of 70° tilt. Heart rate and blood pressure were continuously measured. Of the 48 patients, 30 patients had an abnormal tilt. Subjects with an abnormal tilt had lower systolic, diastolic, and mean arterial blood pressures during tilt, significantly higher levels of vasopressin during HUT, and relatively higher catecholamines and ANG II during HUT than subjects with a normal tilt. Distinct neurohumoral profiles were observed when OI subjects were placed into the following groups defined by the hemodynamic response: postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), syncope, and POTS/syncope. Key characteristics included higher HUT-induced norepinephrine in POTS subjects, higher vasopressin in OH and syncope subjects, and higher supine and HUT aldosterone in OH subjects. In conclusion, children with OI and an abnormal response to tilt exhibit distinct neurohumoral profiles associated with the type of the hemodynamic response during orthostatic challenge. Elevated arginine vasopressin levels in syncope and OH groups are likely an exaggerated response to decreased blood flow not compensated by higher norepinephrine levels, as observed in POTS subjects. These different compensatory mechanisms support the role of measuring neurohumoral profiles toward the goal of selecting more focused and mechanistic-based treatment options for pediatric patients with OI.

Tilt angles and positive response of head-up tilt test in children with orthostatic intolerance

2013 ◽  
Vol 25 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Jing Lin ◽  
Yuli Wang ◽  
Todd Ochs ◽  
Chaoshu Tang ◽  
Junbao Du ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Positive Response ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Appearance Time ◽  
Significant Difference ◽  
Head Up Tilt ◽  
Head Up Tilt Test

AbstractThis study aimed at examining three tilt angle-based positive responses and the time to positive response in a head-up tilt test for children with orthostatic intolerance, and the psychological fear experienced at the three angles during head-up tilt test. A total of 174 children, including 76 boys and 98 girls, aged from 4 to 18 years old (mean 11.3±2.8 years old), with unexplained syncope, were randomly divided into three groups, to undergo head-up tilt test at the angles of 60°, 70° and 80°, respectively. The diagnostic rates and times were analysed, and Wong–Baker face pain rating scale was used to access the children’s psychological fear. There were no significant differences in diagnostic rates of postural orthostatic tachycardia syndrome and vasovagal syncope at different tilt angles during the head-up tilt test (p>0.05). There was a significant difference, however, in the psychological fear at different tilt angles utilising the Kruskal–Wallis test (χ2=36.398, p<0.01). It was mildest at tilt angle 60° utilising the Kolmogorov–Smirnov test (p<0.01). A positive rank correlation was found between the psychological fear and the degree of tilt angle (rs=0.445, p<0.01). Positive response appearance time was 15.1±14.0 minutes at 60° for vasovagal syncope children. There was no significant difference in the time to positive response, at different tilt angles during the head-up tilt test for vasovagal syncope or for postural orthostatic tachycardia syndrome. Hence, it is suggested that a tilt angle of 60° and head-up tilt test time of 45 minutes should be suitable for children with vasovagal syncope.

scholarly journals EVALUATION OF ORTHOSTATIC HYPOTENSION BY USING HUTT

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S737-40
Author(s):  
Qurban Hussain Khan ◽  
Muhammad Asad ◽  
Waqas Baloch ◽  
Mian Muhammad Amer Naseem ◽  
Muhammad Shabbir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Heart Diseases ◽  
Vasovagal Syncope ◽  
Tilt Test ◽  
Baseline Heart Rate ◽  
Baseline Blood Pressure ◽  
Positive Type ◽  
Head Up Tilt ◽  
Head Up Tilt Test

Objective: To determine the prevalence of orthostatic hypotension in our patient population by using Head Up Tilt Test (HUTT). Study Design: Descriptive cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology & National institute of heart diseases, from Jan 2019 to Jan 2020. Methodology: Head Up Tilt Test registry was used as a data collection tool which consisted of gender, age, symptoms, number of episodes, results, baseline blood pressure systolic, baseline blood pressure diastolic, mean blood pressure, baseline heart rate. All patients from age 20-80 undergoing Head Up Tilt Test examination were included while patients already diagnosed with orthostatic hypotension, vasovagal syncope, and cardiac myopathy were excluded from the study. Results: Total 1587 individuals were enrolled in study, I1216 (76.6%) were males and 371 (23.4%) were females. The mean age of the study population was 45.63 ± 19 years. The results determined 67.6 (4.2%) were negative, 7(0.4%) had Vasodepressive Response of vasovagal reflex, 1435 (90.4%) had positive type 1; while 1 (0.1%) had positive type 2; and 4 (0.3%) had positive type 3; 62 (3.9%) had mixed vasovagal reflex, 1 (0.1%) had late orthostatic response and 10 (0.6%) had orthostatic hypotension. Conclusion: Tilt-table testing is an effective method to diagnose orthostatic hypotension.

A clinical manifestation-based prediction of haemodynamic patterns of orthostatic intolerance in children: a multi-centre study

2013 ◽  
Vol 24 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Li Chen ◽  
Xueying Li ◽  
Ochs Todd ◽  
Cheng Wang ◽  
Hongfang Jin ◽  
...  
Keyword(s):  
Clinical Study ◽  
Diagnostic Accuracy ◽  
Clinical Manifestation ◽  
Orthostatic Intolerance ◽  
Vasovagal Syncope ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Multi Centre Study ◽  
Head Up Tilt

AbstractObjective: At present, the haemodynamic diagnosis of orthostatic intolerance is based mainly on the head-up tilt table test, which is sometimes risky for patients. Thus, it is important to find objective and safe methods to differentiate haemodynamic patterns of orthostatic intolerance cases. Methods: In all, 629 children with orthostatic intolerance, either vasovagal syncope or postural orthostatic tachycardia syndrome, were included in the multi-centre clinical study. We analysed the association between the clinical manifestation and haemodynamic patterns of the patients. Results: Syncope after motion with a prodrome of chest distress or palpitations and the concomitant symptom(s) after a syncopal attack, with debilitation, dizziness or headache, were the most important variables in predicting the diagnosis of vasovagal syncope. The overall diagnostic accuracy was 71.5%. Conclusion: Complaint of syncope after motion with prodromal chest distress or palpitation and the concomitant symptom after a syncopal attack, with subsequent debilitation, dizziness or headache, were the most important variables in the diagnosis of vasovagal syncope in children with orthostatic intolerance.

scholarly journals Effects of an Innovative Head-Up Tilt Protocol on Blood Pressure and Arterial Stiffness Changes

2021 ◽  
Vol 10 (6) ◽  
pp. 1198
Author(s):  
Victor N. Dorogovtsev ◽  
Dmitry S. Yankevich ◽  
Nandu Goswami
Keyword(s):  
Blood Pressure ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Healthy Subjects ◽  
Pulse Wave ◽  
Task Force ◽  
Column Height ◽  
Tilt Test ◽  
Test Protocol ◽  
Head Up Tilt

The objective of our study was to identify blood pressure (BP) and pulse wave velocity (PWV) changes during orthostatic loading, using a new the head-up tilt test (HUTT), which incorporates the usage of a standardized hydrostatic column height. Methods: 40 healthy subjects 20–32 years performed HUTT, which was standardized to a height of the hydrostatic column at 133 cm. Exposure time was 10 min in each of 3 positions: horizontal supine 1, HUTT, and horizontal supine 2. The individual tilt up angle made it possible to set the standard value of the hydrostatic column. Hemodynamic parameters were recorded beat to beat using “Task Force Monitor 3040 i”, pulse-wave velocity (PWV) was measured with a sphygmograph–sphygmomanometer VaSera VS1500N. Results: Orthostatic loading caused a significant increase in heart rate (HR) and a decrease in stroke volume (SV) (p < 0.05) but no significant reductions in cardiac output, changes in total vascular resistance (TVR), or BP. An analysis of personalized data on systolic blood pressure (SBP) changes in tilt up position as compared to horizontal position (ΔSBP) revealed non-significant changes in this index in 48% of subjects (orthostatic normotension group), in 32% there was a significant decrease in it (orthostatic hypotension group) and in 20% there was a significant increase in it (orthostatic hypertension group). These orthostatic changes were not accompanied by any clinical symptoms and/or syncope. During HUTT, all subjects had in the PWV a significant increase of approximately 27% (p < 0.001). Conclusion: The new test protocol involving HUTT standardized to a height of hydrostatic column at 133 cm causes typical hemodynamics responses during orthostatic loading. Individual analysis of the subjects revealed subclinical orthostatic disorders (OSD) in up to 52% of the test persons. During HUTT, all test subjects showed a significant increase in PWV. The new innovative HUTT protocol can be applied in multi-center studies in healthy subjects to detect preclinical forms of orthostatic disorders under standard gravity load conditions.

Orthostatic intolerance: orthostatic hypotension and postural orthostatic tachycardia syndrome

ESC CardioMed ◽  
2018 ◽  
pp. 2032-2037
Author(s):  
Artur Fedorowski
Keyword(s):  
Orthostatic Hypotension ◽  
Orthostatic Intolerance ◽  
Wide Spectrum ◽  
Standing Position ◽  
Diagnostic Methods ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Unexplained Syncope ◽  
Clinical Variants ◽  
Age Range ◽  
Specific Symptoms

The impairment of adaptive mechanisms during orthostatic challenge may evoke orthostatic intolerance, a heterogeneous condition, in which the standing position elicits a fall in blood pressure and/or excessive tachycardia, accompanied by a wide spectrum of subjective symptoms such as dizziness, discomfort, nausea, and palpitations. Apart from chronic and potentially debilitating symptoms, orthostatic intolerance may occasionally lead to sudden loss of consciousness and fall injuries. Consequently, orthostatic intolerance should be considered as a possible cause of unexplained syncope. Two main forms of orthostatic intolerance are orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). Clinical variants of OH include initial, classical, and delayed forms. The prevalence of OH increases with age, ranging from less than 5% under 40 years to about 20% above 70 years of age, and is higher in chronic diseases, such as hypertension and diabetes, reaching above 35% in Parkinson’s disease and advanced kidney failure. The presence of OH is associated with a higher mortality and an increased incidence of cardiovascular disease, with the majority of patients being asymptomatic in normal conditions. In contrast, POTS affects predominantly young women (70–80%) within an age range of 15–40 years and is usually accompanied by non-specific symptoms: deconditioning, headache, cognitive impairment, and gastrointestinal dysfunction. Management of orthostatic intolerance includes both non-pharmacological and pharmacological methods with limited efficacy in the severe cases. Empirical treatment with vasoactive and volume expanding drugs for OH and POTS, and rhythm controlling therapy for POTS are recommended. Future studies on syndromes of orthostatic intolerance should focus on mechanisms leading to OH and POTS, novel diagnostic methods, and more effective therapeutic options.

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