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European Heart Journal 2001 22(6):497-503; doi:10.1053/euhj.1999.2007
Copyright © 2001 by the European Society of Cardiology.
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Comparison of provocative tests for unexplained syncope: isoprenaline and glyceryl trinitrate for diagnosing vasovagal syncope

L.A Grahama, J.C Grayb and R.A Kennya,f1

a Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
b Centre for Health and Medical Research, University of Teesside, Newcastle upon Tyne, U.K.

revised October 28, 1999; accepted November 2, 1999

Abstract

Aims To compare the sensitivity, specificity and adverse event profile of glyceryl trinitrate head-up tilt with isoprenaline head-up tilt in the diagnosis of vasovagal syncope in patients with unexplained syncope and healthy controls

Methods and Results Forty-eight patients with unexplained syncope and negative passive head-up tilt at 70 degrees for 40min, and 14 healthy controls underwent glyceryl trinitrate head-up tilt and isoprenaline head-up tilt (maximum dose 5µg.min–1) one week apart in random order. Outcome measures were production of symptoms (syncope, pre-syncope) with development of hypotension. In those with negative passive head-up tilt, the sensitivity of glyceryl trinitrate for diagnosing vasovagal syncope was 48% and the specificity was 71%. Glyceryl trinitrate was well tolerated. Isoprenaline sensitivity was 21% with specificity 64%. Side-effects prevented completion of the test in 68%. Commonest adverse events were the development of hypertension or tachycardia and intolerable flushing or nausea.

Conclusions Glyceryl trinitrate head-up tilt is as effective as isoprenaline head-up tilt as a provocative agent for vasovagal syncope and has a lower incidence of adverse events

Key Words: Syncope, vasovagal syndrome, head-up tilt testing

f1 Correspondence: Professor R. A. Kenny, MD, FRCP(I), FRCP, Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, U.K.

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