PROCEDURE PERFORMED: Head-up tilt table test.
INDICATIONS FOR PROCEDURE: This is a patient status post myocardial infarction and revascularization who has had episodes of lightheadedness and near syncope and therefore was referred for further evaluation.
DESCRIPTION OF PROCEDURE: The risks, benefits and alternatives of the procedure were explained to the patient. All of her questions were answered, and she understood and signed informed consent.
The patient was brought in the fasting nonsedated state. She was tilted to 70 degrees under continuous blood pressure, heart rate, electrocardiogram and pulse oximeter monitoring. Baseline blood pressure was 110/70 and heart rate was 62. Immediately after tilt, the blood pressure was 106/66, and heart rate was 74.
During the next 5 minutes, the blood pressure remained relatively stable at 110/62, and the heart rate was 74. Sublingual nitroglycerin was given, immediately after which the blood pressure was 108/61, and heart rate was 92.
During the next 5 minutes, the heart rate increased to a maximum of 107. Blood pressure dropped to a minimum of 48/palpable, at which time the patient was symptomatic, feeling flushed, lightheaded, nauseated, and almost passing out.
Before the patient passed out, she was returned to supine position. She recovered promptly with a blood pressure of 89/56, and heart rate returned to 52 beats per minute. The patient tolerated the procedure well, and there were no complications.
CONCLUSION: Positive tilt table test with vasodepressor response.
PLAN: The patient has symptoms and tilt table test suggestive of hypotensive episodes. This could be due to a combination of factors including stress, post myocardial infarction situation, and medications. My recommendation would be to increase fluid intake and use support elastic stockings. Other nonpharmacologic measures were discussed. Also, of note, the patient was told that she had episodes of arrhythmia during her exercise training; however, review of the strips shows them to be all artifacts; therefore, there was no evidence of any active ectopic beat or abnormal rhythm.
Tilt Table Test Sample Report #2
PROCEDURE PERFORMED: Head-up tilt table test.
INDICATIONS FOR PROCEDURE: This is a (XX)-year-old male with episodes of near fainting and lightheadedness upon standing and walking. This also happens when he reaches up for things and reaches out for things. The patient has not passed out; however he feels really unbalanced during these episodes. He was referred for further evaluation.
DETAILS OF PROCEDURE: The risks, benefits and alternatives of the procedure were explained to the patient. All his questions were answered, and he understood and signed informed consent.
The patient was brought to the electrophysiology lab in a fasting nonsedated state. He was tilted to 70 degrees under continuous blood pressure, heart rate, EKG, and pulse oximeter monitoring.
Baseline, the blood pressure was 130/74 and heart rate was 110. Immediately after standing, the blood pressure was 124/71 and heart rate was 111.
During the next 5 minutes, blood pressure remained stable at 112/71, heart rate was 116. Sublingual nitroglycerin was given immediately after which the blood pressure was 100/60, heart rate was 115.
During the next 15 minutes, the minimum blood pressure achieved was 54/palp; however, the patient maintained consciousness. His highest heart rate achieved was 123 beats per minute. During this, he only felt warm, hot, slightly lightheaded, however did not pass out throughout, did not experience any similar symptoms that he has had before.
Carotid massage did not cause any significant bradycardia or hypotension.
At the end of the procedure, he was returned to supine position and immediately after that the blood pressure was 88/72 and heart rate was 99.
CONCLUSION: Negative head-up tilt table test.
PLAN: The results of the test are consistent more with an increased response to nitroglycerin and orthostatic hypotension. His history is not compatible with vasovagal; although, it may represent a combination of factors, including the imbalance and equilibrium problems from his other medical conditions.
Adding this to already a tendency to drop the blood pressure can contribute to his symptoms. Therefore, we would recommend the usual treatment for orthostatic hypotension, including increasing fluid and salt intake and using supportive stockings.
Also, other causes such as subclavian steal syndrome or carotid disease should be ruled out. Of note, there was no carotid bruit heard.
