Head-up tilt test – rational using in diagnosis of syncope

Fainting and loss of consciousness (including syncope) are one of the most common causes of medical consultations. A detailed history is of particular importance in their diagnosis. It allows to select a group of patients with a high risk of life-threatening condition and to direct further interdisciplinary process with the participation of a cardiologist, neurologist, psychiatrist and psychologist. The head-up tilt test (HUTT) has a special place in the diagnosis of neurocardiogenic syncope. The main purpose of this review is to highlight the indications for HUTT and indicate situations in which it should be avoided due to the lack of added value of the applied therapy.

Suspension syndrome

Suspension syndrome is a potentially fatal event of unknown incidence that can be caused by motionless hanging in the rope during rope-secured activities. During prolonged hanging, generalized hypoperfusion with reduced cerebral blood flow and consecutive loss of consciousness occurs. Two mechanisms are discussed as the cause leading to loss of consciousness: venous pooling in the legs and a sudden reduction of heart rate and blood pressure, similar to a neurocardiogenic syncope. The most important preventive measure is the activation of the muscle pump during hanging. In principle, the treatment follows standard <C>ABCDE care. The patient should be rescued from the hanging position as fast as possible and airway obstruction caused by hyperflexion of the head during unconscious hanging has to be reversed. There is an increased risk of hyperkalemia. Therefore, ECG monitoring should be established as soon as possible to recognize cardiac arrhythmias. Pulmonary embolism should be considered as a potentially reversible cause of cardiac arrest. Hypothermia prophylaxis and treatment have high priority. For suspension longer than two hours, a medical treatment facility able to provide continuous renal replacement therapy should be chosen. There is no evidence that laying a patient flat immediately after rescue is harmful. Key Words: Neurocardiac Syncope, Venous Pooling, Rescue Death, Generalized Hypoperfusion, Standard <C>ABCDE Care

Syncope

Key Points Most cases of pediatric syncope occur in adolescence and are benign, either neurally mediated syncope (also known as vasovagal or neurocardiogenic syncope) or orthostatic hypotension. In early childhood (6 months to 3 years) syncopal episodes typically result from breath-holding spells, either cyanotic or pallid. A detailed history is most crucial in distinguishing benign syncope from less common but more serious episodes, particularly cardiac- induced syncope or seizures. All patients with syncope need close follow-up to monitor for frequency of episodes and response to any therapeutic interventions.