PURPOSE: Initial orthostatic hypotension is typically associated with active standing and normal autonomic function. Some adolescents in the present study displayed initial orthostatic hypotension during passive tilting, and we hypothesized that this condition was due to abnormal autonomic function. METHODS: The present study compared autonomic functioning in two groups of adolescents: patients with a diagnosis of initial orthostatic hypotension according to the tilt table test and patients with typical symptoms of initial orthostatic hypotension but normal tilt table test results. RESULTS: Significantly higher total composite autonomic severity scores and considerably higher adrenergic index were noted in the tilt table tested group. CONCLUSION: Initial orthostatic hypotension is possibly associated with autonomic dysfunction, especially abnormal vasoconstrictive ability, in individuals diagnosed with a tilt table test. Clinicians should take note of autonomic function when performing diagnoses of initial orthostatic hypotension using the tilt table test.
Adolescent ; Humans ; Hypotension, Orthostatic ; Tilt-Table Test

Aged ; Humans ; Syncope, Vasovagal ; Tilt-Table Test

The causes of a transient loss of consciousness (TLOC) are divided into syncope, epileptic seizures, cerebrovascular diseases and functional disorders such as hyperventilation (HV) syndrome, psychogenic pseudosyncope. The differential diagnosis of TLOC is may be difficult due to lack of history, misleading features, or confusion over the definition of syncope. We have experienced a rare case of HV syncope that TLOC developed after HV from mental stress, and differentiated by head-up tilt table test with transcranial doppler.
Diagnosis, Differential ; Epilepsy ; Humans ; Hyperventilation* ; Syncope* ; Tilt-Table Test* ; Unconsciousness

Child ; Humans ; Postural Orthostatic Tachycardia Syndrome ; diagnosis ; Tilt-Table Test

Child ; Humans ; Syncope, Vasovagal/therapy* ; Tilt-Table Test

PURPOSE: Chronic day-to-day symptoms of orthostatic intolerance are the most notable features of postural orthostatic tachycardia syndrome (POTS). However, we have encountered patients with such symptoms and excessive tachycardia but with no symptoms during the tilt-table test (TTT). We aimed to investigate whether POTS patients with chronic orthostatic intolerance always present orthostatic symptoms during the TTT and analyze the factors underlying symptom manifestation during this test. METHODS: We retrospectively examined patients who presented with POTS at the Gyeongsang National University Hospital between 2008 and 2011. Diagnosis of POTS was based on chronic day-to-day orthostatic intolerance symptoms as well as excessive tachycardia during the TTT. The patients were divided two groups depending on the presentation of orthostatic symptoms during the TTT. Clinical data and the results of the TTT were compared between these groups. RESULTS: In 22 patients, 7 patients (31.8%) did not present orthostatic symptoms during the test. Diastolic blood pressure (BP) was significantly lower in the symptom-positive group. The head-up tilt resulted in a significant increase in diastolic BP in the symptom-negative group (P=0.04), while systolic BP had a tendency to decrease in the symptom-positive group (P=0.06). CONCLUSION: Significant patients with POTS did not present orthostatic symptoms during the TTT despite having chronic daily symptoms. This finding may be important for establishing definitive diagnostic criteria for pediatric POTS. Development of symptoms during TTT might be related to low diastolic BP and abnormal compensatory responses to orthostasis.
Blood Pressure ; Dizziness ; Humans ; Orthostatic Intolerance ; Postural Orthostatic Tachycardia Syndrome ; Retrospective Studies ; Tachycardia ; Tilt-Table Test

BACKGROUND AND OBJECTIVES: The head-up tilt test (HUT) is widely used for the diagnosis of vasovagal syncope. To improve the sensitivity of the test, provocation with isoproterenol is frequently used. The aim of this study was to evaluate the values of isosorbide dinitrate spray as a provocation drug in the HUT. SUBJECTS AND METHODS: Two hundred patients, undergoing baseline HUT (60 degrees for 20 minutes) for suspected vasovagal syncope or presyncope and unexplained dizziness, were enrolled. If the baseline HUT was negative, isosorbide dinitrate (2.5 mg) spray was applied sublingually (group I, n=93), or isoproterenol (3 microgram/min) infused (group II, n=93), in a randomized fashion. The values of isosorbide dinitrate and isoproterenol were compared in those patients that developed a positive vasovagal response or who completed the drug-provocative HUT. RESULTS: Syncope was similarly reproduced in both groups (47.7 vs. 41.9%, p>0.05). Type I responses were most common in both groups, and types I and II responses were more common in group I than group II (78.0 vs. 55.6% and 12.2 vs. 5.6%, p<0.05, respectively). The average time to a positive response was longer in group I than group II (8.5+/-3.4 vs. 6.1+/-3.6 minutes, p<0.01). The sensitivity and specificity of the drug-provocative HUT were significantly higher in group I than group II (73.5 and 87.5% vs. 58.5 and 71.1%; respectively, p<0.01). The incidence of minor adverse effects were similar in both groups, but serious cardiac side effects were significantly more common in group II than group I (4.3 vs. 0%, p<0.05). CONCLUSION: Sublingual isosorbide dinitrate spray may be used as a simple, effective and well tolerated provocative drug during HUT.
Diagnosis ; Dizziness ; Humans ; Incidence ; Isoproterenol* ; Isosorbide Dinitrate ; Sensitivity and Specificity ; Syncope ; Syncope, Vasovagal ; Tilt-Table Test

OBJECTIVETo investigate the common causes of unexplained syncope in children.

METHODSA total of 434 children with unexplained syncope who were aged from 3.0 to 17.9 years (192 males and 242 females) and who saw the doctor between January 2006 and October 2011. were examined in order to explore the detailed histories and causes of syncope and to analyze variance in causes among different ages, genders, syncope frequencies and head-up tilt test (HUTT) results.

RESULTS(1) The causes of occasional syncope included persistent standing (30%), movement (13%), change in body position(9%), sitting(7%), and playing(6%). Persistent standing was more common as a cause in females than in males (P<0.01). Micturition syncope was mainly seen in males. Sultry weather was the main cause of syncope in females. Change in body position was a more common cause in the ≥12 years group than in the <12 years group (P<0.05), while other causes showed no significant differences among different age groups. Change in body position was a more common cause of syncope in children with negative HUTT results than in those with positive HUTT results (P<0.05). (2) All causes of occasional syncope can induce repeated syncope, and most repeated syncope (56%) had the same cause.

CONCLUSIONSThe common causes of unexplained syncope include persistent standing, movement and changes of body position in children. Avoiding these causes is helpful for prevention of childhood syncope.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Male ; Posture ; Syncope ; etiology ; Tilt-Table Test ; Weather

OBJECTIVETo investigate the effects of different tilt angles of head-up tilt test (HUTT) and different responses to HUTT on the psychological fear in children undergoing the test.

METHODSHUTT was performed on children with unexplained syncope or pre-syncope (107 cases: 52 males and 55 females), aged 5.5-17.8 years (mean 12.0±2.8 years). All subjects were randomly assigned to undergo HUTT at an angle of 60°, 70° or 80°; the negative cases underwent sublingual nitroglycerin-provocation HUTT at the same tilt angle. The Wong-Baker Faces Pain Rating Scale was used for self-assessment of psychological fear in subjects during HUTT at the end point of the test.

RESULTSThe positive rate, hemodynamic changes and distribution of response types showed no significant differences between children at tilt angles of 60°, 70° and 80° (P>0.05). The greater the tilt angle, the higher the degree of psychological fear in children undergoing the test, but there were no significant differences between them (P>0.05). The degree of psychological fear in children who showed a positive response to HUTT (n=76) was significantly higher than that in children who showed a negative response (n=31) (P<0.01).

CONCLUSIONSHUTT can cause psychological fear in children undergoing the test, and the degree of psychological fear increases in children tested at tilt angles from 60° to 80°, but the differences have no statistical significance. A positive response to HUTT can significantly increase the psychological fear in children.

Adolescent ; Child ; Child, Preschool ; Fear ; Female ; Humans ; Male ; Tilt-Table Test ; psychology

OBJECTIVETo study the changes in clinical features of vasovagal syncope (VVS) in children.

METHODSFrom January 2000 to September 2009, 841 children with unexplained syncope or prodromata were enrolled. They were assigned to two groups according to the period of visiting hospital: group A (from January 2000 to December 2004, n=129) and group B (from January 2005 to September 2009, n=712). They were assigned to three age groups: 4-6 years old, 7-10 years old and 11-18 years old. A head-up tilt table test (HUTT) was performed on all the subjects.

RESULTSThe total positive rate of HUTT was 45.3% (381/841). Compared with that in group A, the positive rate of HUTT in group B increased significantly (47.5% vs 33.3%; P<0.05). The positive rate of HUTT in female children was significantly higher than that in male children (49.3% vs 37.9%; P<0.05). The positive rate of HUTT increased with age and it was the highest in children at age of 11-18 years (49.2%), followed by in children at age of 7-10 years (44.1%) and 4-6 years (37.1%) (P<0.05). The children at age of 7-10 years and 11-18 years from group B showed significantly higher positive rate of HUTT than those from group A (46.2% vs 27.8%; 54.0% vs 32.6%, P<0.05). Vasodepressor type was the most common response type (70.9%) shown by HUTT compared with mixed type (25.5%) and cardioinhibitory type (3.6%) (P<0.05). The proportion of children with vasodepressor response type in group B was significantly higher than that in group A (72.5% vs 58.1%; P<0.05).

CONCLUSIONSThere were obvious changes in the prevalence of VVS and response types before and after five years, suggesting that the development of VVS may be attributed to many factors, such as social factors, mental factor and life style.

Adolescent ; Child ; Female ; Humans ; Male ; Syncope, Vasovagal ; diagnosis ; Tilt-Table Test