Carotid Artery, Internal ; physiology ; Carotid Body Tumor ; blood supply ; complications ; surgery ; Carotid Sinus ; physiopathology ; Female ; Humans ; Middle Aged ; Syncope ; etiology ; Syndrome

PURPOSE: An association between baroreflex sensitivity (BRS) and the response to tilt training has not been reported in patients with neurally mediated syncope (NMS). This study sought to investigate the role of BRS in predicting the response to tilt training in patients with NMS. MATERIALS AND METHODS: We analyzed 57 patients who underwent tilt training at our hospital. A responder to tilt training was defined as a patient with three consecutive negative responses to the head-up tilt test (HUT) during tilt training. RESULTS: After tilt training, 52 patients (91.2%) achieved three consecutive negative responses to the HUT. In the supine position before upright posture during the first session of tilt training for responders and non-responders, the mean BRS was 18.17+/-10.09 ms/mm Hg and 7.99+/-5.84 ms/mm Hg (p=0.008), respectively, and the frequency of BRS > or =8.945 ms/mm Hg was 45 (86.5%) and 1 (20.0%; p=0.004), respectively. Age, male gender, frequency of syncopal events before HUT, type of NMS, phase of positive HUT, total number of tilt training sessions, and mean time of tilt training did not differ between the study groups. In the multivariate analysis, BRS <8.945 ms/mm Hg in the supine position (odds ratio 23.10; 95% CI 1.20-443.59; p=0.037) was significantly and independently associated with non-response to tilt training. CONCLUSION: The BRS value in the supine position could be a predictor for determining the response to tilt training in patients with NMS who are being considered for inpatient tilt training.
Adult ; Aged ; Baroreflex/*physiology ; Blood Pressure ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Posture ; Predictive Value of Tests ; Sensitivity and Specificity ; Syncope, Vasovagal/*diagnosis/*physiopathology ; Tilt-Table Test/*methods ; Triazoles

OBJECTIVETo investigate the clinical significance of 24-hour blood pressure monitoring (ABPM) for evaluating the treatment outcome of nerve-mediated syncope (NMS) in children.

METHODSTwenty-eight children with NMS confirmed by a head-up tilt table test (HUTT) (12 males and 16 females, aged 6-13 years) and with a chief complaint of unexplained syncope or pre-syncope between February 2010 and August 2012, were included in the study. These children received health education combined with therapy using oral rehydration salts solution and were then reexamined for clinical symptoms as well as HUTT and ABPM results.

RESULTSOf 28 NMS cases, 22 were vasodepressive type, 5 were mixed type, and 1 was cardioinhibitory type. The follow-up showed that 27 (96%) of all cases had improved clinical symptoms, and 18 (64%) had improved HUTT results. The ABPM follow-up revealed no significant changes in 24-hour mean systolic pressure, 24-hour mean diastolic pressure, daytime mean systolic pressure, daytime mean diastolic pressure, nighttime mean systolic pressure, nighttime mean diastolic pressure, day-night difference of systolic pressure, and day-night difference of diastolic pressure after treatment (P>0.05). The percentage of children with a dipper blood pressure pattern increased from 29% (8/28) before treatment to 50% (14/28) after treatment; the percentage of children with a non-dipper blood pressure pattern decreased from 71% (20/28) before treatment to 50% (14/28) after treatment.

CONCLUSIONSAs an effective, objective and non-invasive monitoring means, ABPM is of some clinical significance for evaluating the treatment outcome of NMS in children.

Adolescent ; Blood Pressure Monitoring, Ambulatory ; Child ; Female ; Health Education ; Humans ; Male ; Rehydration Solutions ; administration & dosage ; Syncope ; physiopathology ; therapy ; Tilt-Table Test ; Treatment Outcome

Blood Pressure ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hypertension ; complications ; drug therapy ; physiopathology ; Hypotension, Orthostatic ; complications ; drug therapy ; physiopathology ; Male ; Middle Aged ; Syncope ; complications ; drug therapy ; physiopathology

OBJECTIVETo study the clinical value and safety of the head-up tilt table test (HUTT) in children under 6 years old.

METHODSThe HUTT results between September 2000 and August 2011 of 144 2 to 6-year-old children (81 boys and 63 girls) with syncope and dizziness of unknown causes were retrospectively studied.

RESULTSEight children completed the based tilt table test and 136 cases completed the sublingual nitroglycerin tilt table test. No serious side effects were found in these children. Thirty-two (22.2%) of the 144 children had a positive result of HUTT, including 18 boys and 14 girls (P>0.05). When HUTT-induced syncope met positive standards, ECG record and blood pressure recovered to normal levels within 5 minutes by changing the position of the test bed, keeping the airway open, nasal oxygen inhalation and oral milk.

CONCLUSIONSThe HUTT is valuable, safe and compliant in children under 6 years old.

Age Factors ; Blood Pressure ; drug effects ; Child ; Child, Preschool ; Dizziness ; diagnosis ; physiopathology ; Electrocardiography ; drug effects ; Female ; Humans ; Male ; Nitroglycerin ; pharmacology ; Retrospective Studies ; Syncope ; diagnosis ; physiopathology ; Tilt-Table Test

BACKGROUND/AIMS: This study elucidated the prognostic factors for neurocardiogenic syncope in males in their late teens and early twenties. METHODS: Tilt-table testing (TTT) was performed on 665 males (age range, 17 to 27 years) following the Italian protocol. The subjects were tilted head-up at a 70degrees angle on a table for 30 minutes during the passive phase. If the passive phase was negative, the subjects were given sublingual nitroglycerin and tilted to the same angle for 20 minutes during the drug-provocation phase. The subjects with positive results were followed without medication. We analyzed factors related to the recurrence rate of syncope. RESULTS: Of 305 subjects (45.8%) with positive results, 223 (age range, 18 to 26 years) were followed for 12 months. The frequency of previous syncopal episodes > or = 4 (p = 0.001) and a positive result during the passive phase (p = 0.022) were significantly related to a high recurrence rate. A positive result during the early passive phase (< or = 12 minutes) was significantly related to a higher recurrence rate than was that during the late passive phase (> 12 minutes; p = 0.011). CONCLUSIONS: A positive result during the early passive phase of TTT and frequent previous syncopal episodes were prognostic factors for neurocardiogenic syncope in men in their late teens and early twenties.
Adolescent ; Adult ; Age Factors ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Recurrence ; Republic of Korea ; Sex Factors ; Syncope, Vasovagal/*diagnosis/physiopathology ; *Tilt-Table Test ; Time Factors ; Young Adult

OBJECTIVETo study the clinical characteristics of orthostatic hypertension (OHT) in children.

METHODA total of 96 children with OHT who met the diagnostic criteria and clinical manifestations were recruited in the Department of Pediatrics, Peking University First Hospital. Age and sex distributions were observed. The duration of disease, the frequencies of symptoms and the predisposing factors were recorded. The hemodynamic changes from supine to up-right positions were also analyzed.

RESULTThere were 50 boys and 46 girls in the study group. The mean age was (11.8 ± 2.7) years. Thirty-two children were from 6 to 10 years old, accounting for 33.3% of all subjects, while 64 patients were from 11 to 17 years old, accounting for 66.7%. Durations of symptoms of OHT were less than 1 month in 22.9% children, from 1 month to 1 year in 51.1% children and longer than 1 year in 26.0% children. The most common clinical manifestations were syncope and dizziness. The incidence of them was 70.8% and 46.9%, respectively. Other clinical manifestations included transitional amaurosis, nausea and/or vomiting, pallor and so on. These clinical manifestations often occurred on position change (24.0%) and long-time standing (57.3%) in children. Other predisposing factors included exercise, emotion changes and fuggy environment. The baseline systolic and diastolic blood pressures were (103 ± 8) mm Hg (1 mm Hg = 0.133 kPa) and (59 ± 6) mm Hg, respectively, the up-right systolic and diastolic blood pressure at 3 min were (113 ± 8) mm Hg and (73 ± 6) mm Hg and the differences were significant (t = 27.674, P < 0.01; t = 17.936, P < 0.01). The baseline heart rate in supine position was (81 ± 11) bpm and the maximum heart rate in up-right position was (113 ± 12) bpm (t = 33.092, P < 0.01).

CONCLUSIONOHT is commonly seen in puberty of children. The chief complaints are syncope and dizziness. They were mostly induced by position change and long-time standing. Blood pressure was significantly increased from supine to up-right position.

Adolescent ; Blood Pressure ; physiology ; Child ; Dizziness ; epidemiology ; physiopathology ; Female ; Heart Rate ; Humans ; Hypotension, Orthostatic ; epidemiology ; etiology ; physiopathology ; Male ; Multivariate Analysis ; Posture ; Risk Factors ; Syncope ; epidemiology ; physiopathology

Adolescent ; Autonomic Nervous System ; physiopathology ; Blood Pressure ; physiology ; Blood Pressure Monitoring, Ambulatory ; methods ; Child ; Child, Preschool ; Circadian Rhythm ; Female ; Heart Rate ; physiology ; Humans ; Male ; Posture ; physiology ; Syncope, Vasovagal ; diagnosis ; etiology ; physiopathology ; Tilt-Table Test ; Vagus Nerve ; physiopathology

Arrhythmias, Cardiac ; complications ; physiopathology ; Atrioventricular Block ; complications ; physiopathology ; Coronary Circulation ; Humans ; Male ; Middle Aged ; Syncope ; complications ; physiopathology

Animals ; Neurotransmitter Agents ; metabolism ; Rabbits ; Syncope, Vasovagal ; metabolism ; physiopathology