Key result
Tilt testing effectively differentiates unexplained syncope types to guide appropriate therapy.
Tilt testing is a clinically useful, albeit time-consuming, method to diagnose and differentiate causes of unexplained syncope to guide therapy.
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Supports tilt testing for differentiating syncope causes; leaves open its effect on clinical outcomes.
Tilt testing can help to diagnose unexplained syncope, by precipitating an episode during cardiac monitoring. The Italian protocol, now most widely used, involves giving sublingual nitroglycerine after 15 min, while monitoring beat-to-beat blood pressure (BP) and recording on video. Tilt testing is time-consuming but it is clinically useful and can guide therapy. Complications are rare. Syncope types include vasovagal syncope where BP falls after >3 min of tilt-up and later the heart rate falls; classic orthostatic hypotension where there is an immediate, progressive BP fall with minimal heart rate change; delayed orthostatic hypotension with a late BP fall after a stable phase but little or no heart rate rise; psychogenic pseudosyncope with apparent loss of consciousness, but no BP fall and a moderate heart rate rise; and postural orthostatic tachycardia syndrome where there is a significant heart rate rise but no BP fall.
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Cooper et al. (2023) conducted a review in unexplained syncope. Tilt testing was evaluated. Tilt testing is a clinically useful diagnostic tool for unexplained syncope that helps differentiate between vasovagal syncope, orthostatic hypotension, and other types to guide therapy.
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