Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Lunzer, L.
Cardiovascular Control During Tilt-Table Testing in Patients with Histories of Syncope: Case Studies
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 69
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Goswami Nandu
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- Abstract:
- Background: Orthostatic dysregulation is a very common problem, especially in older people and young women. The orthostatic dysregulation/syncope is a dysregulation/syncope caused by a malfunction of the orthostatic reaction. In healthy people, the orthostatic reaction ensures that the cardiovascular system works correctly in an upright position. In the case of a deficient regulation, the orthostatic regulation does not work as it should after standing up, and orthostatic dysregulation occurs. The symptoms of orthostatic dysregulation appear after a rapid change in position, especially from that of lying down to standing up. These complaints force those affected to sit or lie down. In some cases, syncope may also occur. [2] Aims and objectives: This diploma thesis aims to examine the physiology of cardiovascular regulation and the physiology of orthostatic dysregulation as well as its diagnosis and therapy. Furthermore, this diploma thesis provides a brief insight into the most common differential diagnoses of orthostatic dysregulation. Methodology: The data presented here are from LKH Knittelfeld, where tilt-table testing was performed to diagnose an orthostatic intolerance. Due to the Data Protection Act and patient confidentiality, only two patients (one with orthostatic intolerance and one without) were included in this thesis. They both underwent tilt-table testing for a diagnosis. The haemodynamic data were measured using a Task Force Monitor (CNSystems, Graz). Results: Both patients were males and above 80 years of age. One of these patients had a positive tilt test and was therefore diagnosed with orthostatic intolerance, while the other had a negative tilt test. The patient suffering from tilt-table-induced syncope experienced a decrease in the systolic blood pressure (from about 152 mmHg to 110 mmHg) at the beginning of the tilt test. Simultaneously, the heart rate increased slightly. Eighteen minutes after the passive head-up tilt was started, the systolic blood pressure decreased to 75mmHg. At this point, the heart rate decreased as well, and the patient experienced syncope. In comparison, the patient without orthostatic intolerance (i.e. whose tilt test was negative) had quite a constant blood pressure and heart rate throughout the test. Discussion: The data showed the differences in cardiovascular responses between the patient who experienced syncope during tilt-table-testing and the patient who did not. These case studies show that the compensatory mechanisms involved in blood-pressure regulation during tilt-table testing are inappropriate in patients with a positive tilt test. In addition to ageing, several factors increase the risk of orthostatic intolerance. While the case studies presented here are only based on two individuals, the strength of this study lies in that differences can be seen in the cardiovascular response between patients suffering from and not suffering from orthostatic intolerance during tilt-table testing even when only examining two patients. This study can be used as a base for future studies in which a larger number of patients could be assessed during tilt-table testing, particularly to understand the underlying mechanisms that predispose some patients to syncope but not others.