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Europace Advance Access originally published online on August 6, 2008
Europace 2008 10(9):1091-1094; doi:10.1093/europace/eun196
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Syncope

Head-up tilt testing with different nitroglycerin dosages: experience in elderly patients with unexplained syncope

Ana Teresa Timoteo*, Mario Martins Oliveira, Joana Feliciano, Eduardo Antunes, Manuel Nogueira da Silva, Sofia Silva, Sofia Santos and Rui Ferreira

Cardiology Department, Santa Marta Hospital, R. Santa Marta, 1169-024 Lisboa, Portugal

Aims: Protocols using sublingual nitrates have been increasingly used to improve diagnostic accuracy of head-up tilt testing (HUT). Nevertheless, exaggerated responses to nitrates have been frequently described, particularly in elderly patients. The aim of this article is to evaluate, in an elderly population with unexplained syncope, whether the impact of sublingual nitroglycerin (NTG) used as a provocative agent is dose-dependent.

Methods and results: One hundred and twenty consecutive elderly patients submitted to HUT using NTG after an asymptomatic drug-free phase were studied. Patients were divided into three groups according to the NTG dosage: 500, 375 and 250 µg. The test was considered positive when there was reproduction of symptoms with bradycardia and/or arterial hypotension. A gradual decrease in the blood pressure after NTG was considered an exaggerated response to nitrates. There were no differences in the clinical characteristics of the different subgroups. A positive test was obtained in 50% of the patients in each group. The rate of exaggerated responses was identical in all groups and ranged between 15 and 17%.

Conclusion: In an elderly population with syncope of unknown origin submitted to HUT, the response to NTG is not dose-dependent, and no difference was found in the rate of exaggerated responses to nitrates with different NTG dosages.

Key Words: Head-up tilt testing, Nitroglycerin dosages, Elderly

* Corresponding author: Av. Miguel Torga, No. 27, Edificio C, 9°A, 1070-183 Lisboa, Portugal. Tel: +351 21 3594311.E-mail address: ana_timoteo{at}yahoo.com

Manuscript submitted 8 May 2008. Accepted after revision 10 July 2008.


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