Sublingual nitrates during head-up tilt testing for the diagnosis of vasovagal syncope

• Published in: The American heart journal Vol. 133; no. 5; pp. 504 - 507
• Main Authors: Aerts, Arnaud, Dendale, Paul, Strobel, Gunnar, Block, Pierre
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.1997; Elsevier
• Subjects: Administration, Sublingual; Adult; Biological and medical sciences; Case-Control Studies; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Isosorbide Dinitrate - administration & dosage; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Sensitivity and Specificity; Space life sciences; Syncope, Vasovagal - diagnosis; Tilt-Table Test - methods; Vasodilator Agents - administration & dosage; Human; Pharmacologic test; Head position; Nervous system diseases; Associated technique; Isosorbide dinitrate; Vasodilator agent; Consciousness impairment; Sublingual administration; Vasovagal syncope; Sensitivity; Specificity; Test; Organic nitrate; Diseases of the autonomic nervous system; Diagnosis; Neurological disorder
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(97)70144-3

Pharmacologic stimulation during head-up tilt test (HUT) is used to increase the diagnostic yield of the test to detect vasovagal syncope. Reported lack of specificity of stimulation with intravenous isoproterenol has made a pharmacologic alternative desirable. Because nitrates are known to cause syncope of a vasovagal origin, we administered sublingual nitrates after classic tilt test in 32 patients with a history of typical vasovagal syncope and 20 healthy volunteers to assess the sensitivity, specificity, and accuracy of this new HUT technique. During the classic HUT four (13%) patients had syncope; after administration of sublingual nitrates, this number increased to 28 (87%). In the control group no subject had syncope during classic HUT, whereas during nitrate administration six (30%) had syncope. Sublingual nitrate stimulated HUT revealed a maximum accuracy of 83% at a cutoff point of 11 minutes, giving a sensitivity of 81% and specificity of 85%. Sublingual nitrate administration increased the accuracy of HUT in diagnosing vasovagal syncope in patients with a history of typical vasovagal syncope. (Am Heart J 1997;133:504-7.)