QUANTITATIVE TILT-TABLE EXAMINATION WITH TCD MONITORING IN THE DIAGNOSIS OF NEUROCARDIOGENIC SYNCOPE (VASOVAGAL SYNCOPE)

The clincal significance of quantitative tilt-table examination with TCD monitoring in the diagnosis of neurocardiogenic syncope is evaluated. A 50-year-old male suffered a neurocardiogenic syncope during tilt-table examination with a strong drop in blood pressure, an increase in cerebrovascular resistance as evidenced by transcranial Doppler monitoring, and a 30-s cardiac asystole, followed by a generalized seizure. No further syncope could be elicited during tilt-table examination after beta-blocker treatment, It was hypothesized that hyperactivity of the left ventricular mechanoreceptors due to increased force of ventricular contraction during a state of reduced venous backstream to the heart was responsible for eliciting the neurocardiogenic syncope. Tilt-table examination with an upright position for at least 45 min enables the diagnosis of a neurocardiogenic syncope to be made with sufficient sensitivity and specificity. Several studies have shown that medication with beta-blockers is successful in the treatment of neurocardiogenic syncope. The implantation of cardiac pacemakers should only be considered if medication is not successful.