DATE OF PROCEDURE: MM/MM/YYYY
REFERRING PHYSICIAN: John Doe, MD
PROCEDURE PERFORMED: Tilt table test.
INDICATIONS FOR PROCEDURE: Syncope.
DESCRIPTION OF PROCEDURE: The patient was brought to the electrophysiology laboratory in the fasting state. After signing informed consent, she was laid supine on the tilt table and noninvasive blood pressure cuff monitoring, ECG monitoring and pulse oximetry monitoring were established. The patient was observed in the supine position for several minutes during which time heart rates were in the 70 to 80 beat per minute range with systolic blood pressures 114/133.
She was then tilted to the head-up position to 75 degrees and observed for a total of 30 minutes. Heart rate and rhythm were observed continuously and blood pressures were measured every minute. The patient was stable throughout the 30-minute tilt with sinus rhythm in the 70 to 90 beat per minute range and systolic blood pressures ranging between 94 and 134 beats mmHg. The patient did not have significant symptoms during the initial tilt.
She was then lowered supine and isoproterenol was begun at a dose of 1 mcg per minute, which resulted in an acceleration of her resting heart rate from 68 to 80. She was then tilted again to 75 degrees. The patient initially did well, but after 20 minutes of tilt, the patient started feeling nauseated and blood pressure fell into the 90s and then subsequently rapidly into as low as 58/40 without compensatory acceleration of her heart rate, which was running in the 80 to 100 beat per minute range.
The patient was intensely near syncopal at this point but never did lose consciousness. We observed her for 20 to 30 seconds, during which time she remained highly symptomatic, but did not lose consciousness. During this interval, her radial pulse was absent confirming the presence of hypotension.
She was then lowered supine. Radial pulse returned and blood pressure normalized. All the patient’s near-syncopal symptoms resolved. The patient states that these symptoms were similar to what she experienced in her prodromal episode prior to syncope 3 months ago. The patient then left the electrophysiology laboratory in stable condition.
IMPRESSION: Positive tilt testing reproducing near-syncope in the setting of hypotension due to orthostatic hypotension during prolonged head-upright tilt on isoproterenol stimulation.
