PURPOSE: Some patients with neurally mediated reflex syncope may be misdiagnosed as epilepsy because myoclonic jerky movements are observed during syncope. The seizure-like activities during the head-up tilt test (HUT) have been rarely reported. The purpose of this study was to assess the characteristics of these seizure-like activities and evaluate whether there are differences in the clinical characteristics and hemodynamic parameters of patients with neurally mediated reflex syncope with and without seizure-like activities during HUT-induced syncope. MATERIALS AND METHODS: The medical records of 1,383 consecutive patients with a positive HUT were retrospectively reviewed, and 226 patients were included in this study. RESULTS: Of 226 patients, 13 (5.75%) showed seizure-like activities, with 5 of these (2.21%) having multifocal myoclonic jerky movements, 5 (2.21%) having focal seizure-like activity involving one extremity, and 3 (1.33%) having upward deviation of eye ball. Comparison of patients with and without seizure-like activities revealed no significant differences in terms of clinical variables and hemodynamic parameters during HUT. CONCLUSION: Seizure-like activities occurred occasionally during HUT-induced syncope in patients with neurally mediated reflex syncope. The seizure-like activities during HUT might not be related to the severity of the syncopal episodes or hemodynamic changes during HUT.
Adult ; Epilepsy/*pathology ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Syncope/*diagnosis/*etiology/pathology ; Tilt-Table Test/*adverse effects ; Young Adult

OBJECTIVETo evaluate the serious response during tilt-table test (TTT) and its prophylactic management.

METHODSeventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct.

RESULTSFifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II degrees -I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications.

CONCLUSIONAlthough non-invasive, TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.

Aged ; Female ; Heart Diseases ; complications ; diagnosis ; physiopathology ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; Patient Selection ; Syncope ; etiology ; prevention & control ; Tilt-Table Test ; adverse effects

OBJECTIVE: To study the clinical features and intervention strategies of head-up tilt table test (HUTT) induced syncope triggering convulsion. METHODS: HUTT was performed in 2377 cases (male 1116 cases and female 1261 cases) with syncope, dizziness, headache, chest tightness at Second Xiangya Hospital of Central South University from September 2000 to August 2011. They were 2.00-78.00 (18.57±14.36) years old, 1719 cases were younger than 18 years (the children group) [(2.00-17.92 (10.88±3.02) years] and 658 were older than 18 years (the adult group) [(18.00-78.00 (38.66±12.87) years]. We analyzed the related factors for inducing syncope triggering convulsion symptom and other serious side effects in HUTT. RESULTS: 1) Eighty-nine patients (3.74%) induced syncope with convulsion symptoms during HUTT, with more adults (62.92%) than children (37.08%) (χ(2)=87.842, P<0.01). 2) Sinus cardiac arrest and heart rate recovery time: 25 (28.09%) out of the 89 patients had sinus cardiac arrest. The sinus cardiac arrest time was 3.00-14.60 (7.90±3.44) s. After the HUTT, the heart rate recovery time was 0.50-37.00 (3.05±4.11) min, 70 of which (78.65%) resumed 3 min. 3) INTERVENTIONS: when all patients completed the HUTT, they would take oxygen and drink milk and other measures to relieve convulsions and recover heart rate and blood pressure. No one died, and the vital signs of 2 patients returned to normal after intravenous administration. CONCLUSION Induced syncope triggering convulsion symptom in HUTT is more common in adult patients. Convulsions disappear and heart rate and blood pressure return to normal after taking oxygen and milk and other measures. HUTT in clinical practice is safe, and can be used in patients of all ages.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Seizures ; etiology ; therapy ; Syncope ; etiology ; therapy ; Tilt-Table Test ; adverse effects ; Young Adult

OBJECTIVEto study the characteristics of arrhythmia after a positive head-up tilt table test (HUTT).

METHODShead-up tilt table test (BHUT) or sublingual nitroglycerin-provocation head-up tilt table test (SNHUT) were performed in 1374 patients at the Second Xiangya Hospital of Central South University from March of 2001 to August of 2009. Arrhythmias were recorded in 169 patients after a positive HUTT [57 male, age 6 - 65 years, 86 children < 18 years, mean age (23.1 ± 14.8) years].

RESULTSarrhythmias developed in 75 patients (44.38%) post a positive BHUT and in 94 patients (55.62%) post a positive SNHUT. Major types of arrhythmias were sinus bradycardia (143/169, 84.62%), junctional escape rhythm (55/169, 32.54%) and sinus arrest (26/169, 15.38%). Sinus bradycardia was more common in adult (P < 0.01). Occurrence of junctional escape rhythm and sinus arrest was not affected by age, gender and test mode. Arrhythmia and the manifestation of syncope or pre-syncope occurred simultaneously in 77 (45.56%) patients and mainly in BHUT, while arrhythmia appeared later than the syncope manifestation in 92 (54.44%) patients and mainly in SNHUT (P < 0.05). Arrhythmia and blood pressure reduction occurred simultaneously in 84 (53.50%) cases and mainly in BHUT, while arrhythmia appeared later than reduction of blood pressure in 73 (46.50%) cases and mainly in SNHUT (P < 0.01).

CONCLUSIONS(1) the common types of arrhythmia were sinus bradycardia, junctional escape rhythm and sinus arrest after a positive HUTT. Occurrence of sinus arrest was not affected by age, gender and test mode. (2) In BHUT, arrhythmia occurred mostly simultaneously with the manifestation of syncope or pre-syncope and blood pressure reduction, while arrhythmia appeared later in SNHUT.

Adolescent ; Adult ; Aged ; Arrhythmias, Cardiac ; etiology ; Child ; Female ; Humans ; Male ; Middle Aged ; Syncope ; etiology ; Tilt-Table Test ; adverse effects ; Young Adult