Key result
Tilt table testing revealed diminished LVAD flow and pulsatility leading to severe orthostatic hypotension as the cause of recurrent syncope in a patient 15 months post-LVAD implantation.
Why the study?
Autonomic dysfunction leading to orthostatic hypotension is common but not well described in patients with chronic LVAD support, where decreased pulsatility makes diagnosis challenging.
Case Report (n=1)
Tilt table testing can be useful in evaluating orthostatic hypotension in patients with chronic LVAD support presenting with syncope.
May support tilt table testing for syncope in chronic LVAD patients; leaves open need for prospective validation.
We report a case of a 55-year-old man who presented with recurrent syncope 15 months after HeartWare left ventricular assist device (LVAD) implantation and was found to have diminished LVAD flow and pulsatility on tilt table testing leading to severe orthostatic hypotension (OH). The prevalence of OH is common, but autonomic dysfunction leading to OH has not been well described in patients with chronic LVAD support. The diagnosis of OH in this setting is challenging due to the decreased pulsatility in the flow generated by LVADs, and tilt table testing can be useful in the evaluation of OH in these patients.
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Money et al. (2020) conducted a case report in Recurrent syncope and severe orthostatic hypotension (n=1). Tilt table testing was evaluated on Diagnosis of severe orthostatic hypotension. Tilt table testing revealed diminished LVAD flow and pulsatility leading to severe orthostatic hypotension as the cause of recurrent syncope in a patient 15 months post-LVAD implantation.
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