Características do Tilt-Teste em 348 Pacientes
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O documento descreve um estudo sobre o teste de inclinação (tilt test) em 348 pacientes. Os principais resultados foram: 1) O tilt test foi positivo em 53,2% dos casos, semelhante aos achados da literatura. 2) A resposta mais comum foi a síncope vasovagal (32% dos pacientes). 3) Foi necessário usar medicação sensibilizadora (Isordil) em quase 90% dos pacientes para induzir a síncope.
![Síncope é um sintoma com as seguintes características: ,[object Object],[object Object],[object Object],[object Object],[object Object],EHJ. 2001;22:1256-1306. O mecanismo subjacente é uma hipoperfusão cerebral global transitória.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Características do Tilt-Teste em 348 Pacientes
- 1. Características e Resultados do Teste de Inclinação na População Geral CARLOS A V LOVATTO, FLÁVIA PEZZIN, FABRICIO S VASSALLO, STEPHANIE Í RIZK, ALBERTO N P JÚNIOR, ALOYR G S JUNIOR, EDUARDO G SERPA, HERMES CARLONI A, RENATO G SERPA, PEDRO A R RESECK e LUIZ M F D NASCIMENTO.
- 3. Fundamentos
- 4. A Importância da Síncope 1 National Disease and Therapeutic Index on Syncope and Collapse, ICD-9-CM 780.2, IMS America, 1997 2 Blanc J-J, L’her C, Touiza A, et al. Eur Heart J, 2002; 23: 815-820. 3 Day SC, et al, AM J of Med 1982 4 Kapoor W. Evaluation and outcome of patients with syncope. Medicine 1990;69:160-175
- 8. Tipo de resposta e tempo de positivação na literatura. Oraii, Maleki, Minooii, et al. Heart 1999; 81:603–605
- 12. Tilt Teste Positivo num Paciente com Síncope Neuromediada Sra JS. Ann Intern Med. 1991;114:1013-1019.
- 15. Resultados SVV : 53%
Notas do Editor
- Hipoperfusão SNC por falência do SNA em manter PA e FC adequados para manutenção da PPC e nível de consciência.
- Syncope is a relatively common problem that affects over 1 million people in the U.S. each year. Syncope accounts for 1 to 6% of hospital admissions and 3% of emergency room visits each year. 1,2 The incidence of syncope is greater than 500,000 new patients per year. 1.National Disease and Therapeutic Index on Syncope and Collapse, ICD-9-CM 780.2, IMS America, 1997. 2. Blanc J-J, L’Her C, Touiza A, et al. Prospective Evaluation and Outcome of Patients Admitted for Syncope Over a 1-Year Period. Eur Heart J, 2002; 23: 815-820. 3.Day SC, et al. Evaluation and outcome of emergency room patients with transient loss of consciousness. Am J Med 1982;73:15-23. 4.Kapoor W. Evaluation and outcome of patients with syncope. Medicine 1990;69:160-175.
- Multiple reports have examined the frequency with which syncope occurs in various populations. This slide provides an overview of such findings. In essence the frequency with which syncope is reported to have occurred in various study groups is approximately 20%. The basis for syncope would be expected to differ substantially among these groups. Younger patients will have a greater proportion of vasovagal syncope, whereas older individuals may reasonably be expected to have a higher likelihood of underlying structural heart disease, and hence a greater predilection to more worrisome etiologies. Brignole M, Alboni P, Benditt DG, et al. “Guidelines on Management (Diagnosis and Treatment) of Syncope. Eur Heart J 2001; 22: 1256-1306.
- Syncope must be differentiated from other “non-syncopal” conditions which also lead to transient loss of consciousness. The subdivision of syncope is based on pathophysiology as follows: “ Neurally-mediated reflex syncopal syndrome” refers to a reflex that, when triggered, gives rise to vasodilatation and bradycardia, although the contribution of both to systemic hypotension and cerebral hypoperfusion may differ considerably. ‘ Orthostatic’ syncope occurs when the autonomic nervous system is incapacitated resulting in a failure of vasoconstrictor mechanisms and thereby in orthostatic hypotension; ‘Volume depletion’ is another important cause of orthostatic hypotension and syncope ‘ Cardiac arrhythmias’ can cause a decrease in cardiac output, which usually occurs irrespective of circulatory demands. ‘ Structural heart disease’ can cause syncope when circulatory demands outweigh the impaired ability of the heart to increase its output. ‘ Steal’ syndromes can cause syncope when a blood vessel has to supply both part of the brain and an arm. Causes of Non-syncopal Attacks (Commonly Misdiagnosed as Syncope) A) Disorders with impairment or loss of consciousness: 1) Metabolic disorders*, including hypoglycaemia, hypoxia, hyperventilation with hypocapnia; 2) Epilepsy; 3) Intoxication; 4) Vertebro-basilar transient ischaemic attack (TIA). B) Disorders resembling syncope without loss of consciousness: 1) Cataplexy; 2) Drop attacks; 3) Psychogenic ‘syncope’ (somatization disorders)**; 4) TIA of carotid origin *Disturbance of consciousness probably secondary to metabolic effects on cerebrovascular tone. **May also include hysteria, conversion reaction. Pathophysiological classification of the principle known causes of transient loss of consciousness. Adapted from EHJ. 2001;22(15):1260, Table 1.1
- SVV : ~18 - 22% Situacional : 5% Seio carotídeo : 1% This slide provides a simple classification of the principal causes of syncope, and may be helpful in thinking about the strategy for evaluating syncope in individual patients. Within the boxes,the most common causes of syncope are indicated for each of the major diagnostic groups. The numbers at the bottom of each column provide an approximate value for the average frequency with which that category appears in published report summarizing diagnostic findings (Alboni J Am Coll Cardiol 2001; 37: 1921-1928 ). It should be noted that orthostatic causes are not often referred to specialists and consequently tend to be under represented in the literature.
- Tipo 1 : mista Tipo 2 : cardioinibitória Tipo 3 : vasodepressora
- Sensibilidade e especificidade podem variar conforme protocolo usado.Sem a adm de medicamentos a Sensibilidade varia entre 30 e 80% e a especificidade por volta de 90%. Com estimulo farmacológico ocorre redução da especificidade permanecendo ainda em níveis confiáveis.
- The rationale for undertaking head-up tilt (HUT) testing in patients suspected of having vasovagal syncope is summarized here. In essence, the test may not only provide useful diagnostic information, but it also provides an opportunity for patients to become more familiar with the condition and its possible warning signs. The latter may prove to be of considerable diagnostic utility in many individuals.
- Syncope in vasovagal fainters, as in other forms of neurally-mediated reflex syncope, is due to systemic hypotension resulting in a transient period of inadequate cerebral blood flow. Hypotension is the result of 2 pathophysiologic components: 1. Marked bradycardia or inappropriately slow heart rate for the blood pressure (i.e., cardioinhibitory feature) 2. Vasodilatation The relative contribution of these 2 components varies among patients
- ---Para diminuir chance de falso positivo pode ser feita infusão parenteral de fluidos (SF 75ml/h) antes do procedimento ---Suspender drogas antes do exame de acordo com meia vida ---A duração na posição inclinada é a maior determinante na sensibilidade e especificidade do exame ---