Transcranial Doppler Ultrasonography during Head-Upright Tilt-Table Testing

Brief Communications1 December 1995Transcranial Doppler Ultrasonography during Head-Upright Tilt-Table TestingCarey S. Fredman, MD, Kurt M. Biermann, RN, BSN, Vipool Patel, MD, Erica L. Uppstrom, MD, and Arthur I. Auer, MDCarey S. Fredman, MDFrom St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri., Kurt M. Biermann, RN, BSNFrom St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri., Vipool Patel, MDFrom St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri., Erica L. Uppstrom, MDFrom St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri., and Arthur I. Auer, MDFrom St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-11-199512010-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Head-upright tilt-table testing is often used to support the diagnosis of vasovagally mediated syncope [1-4]. Studies that have looked at the hemodynamic changes that occur during head-upright tilt-table testing [1] have shown that positive test results are often associated with both systemic hypotension and bradycardia and that hypotension almost always precedes bradycardia. In a minority of positive tilt-table tests, syncope results from hypotension alone.Recently, a paradoxical increase in cerebrovascular resistance was shown to occur concomitantly with the development of hypotension and bradycardia in patients who had syncope during tilt-table testing [5]. We describe a previously unreported response in a ...References1. Abi-Samra F, Maloney JD, Fouad-Tarazi FM, Castle LW. The usefulness of head-up tilt testing and hemodynamic investigations in the workup of syncope of unknown origin. PACE Pacing Clin Electrophysiol. 1988; 11:1202-14. Google Scholar2. Almquist A, Goldenberg IF, Milstein S, Chen MY, Chen XC, Hansen R, et al. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med. 1989; 320:346-51. Google Scholar3. Sra JS, Anderson AJ, Sheikh SH, Avitall B, Tchou PJ, Troup PJ, et al. Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing. Ann Intern Med. 1991; 114:1013-9. Google Scholar4. Grubb BP, Temesy-Armos P, Hahn H, Elliott L. Utility of upright tilt-table testing in the evaluation and management of syncope of unknown origin. Am J Med. 1991; 90:6-10. Google Scholar5. Grubb BP, Gerard G, Roush K, Temesy-Armos P, Montford P, Elliott L, et al. Cerebral vasoconstriction during head-upright tilt-induced vasovagal syncope. A paradoxic and unexpected response. Circulation. 1991; 84:1157-64. Google Scholar6. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982; 57:769-74. Google Scholar7. Petty GW, Wiebers DO, Meissner I. Transcranial Doppler ultrasonography: clinical applications in cerebrovascular disease. Mayo Clin Proc. 1990; 65:1350-64. Google Scholar8. Kontos HA. Validity of cerebral arterial blood flow calculations from velocity measurements. Stroke. 1989; 20:1-3. Google Scholar9. Fouad FM, Tadena-Thome L, Bravo EL, Tarazi RC. Idiopathic hypovolemia. Ann Intern Med. 1986; 104:298-303. Google Scholar Author, Article, and Disclosure InformationAffiliations: From St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri.Acknowledgments: The authors thank Katheryne Dieckmann and Rebecca Nappier for technical assistance and Nancy La Chance for secretarial help in preparing the manuscript.Corresponding Author: Carey S. Fredman, MD, FACC, Electrophysiology Laboratory and Pacemaker Services, St. John's Mercy Heart Center, 621 South New Ballas Road, #3005-B, St. Louis, MO 63141.Current Author Addresses: Dr. Fredman: Electrophysiology Laboratory and Pacemaker Services, St. John's Mercy Heart Center, 621 South New Ballas Road, #3005-B, St. Louis, MO 63141. 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