Zusammenfassung
Die Kipptischuntersuchung ist eine hervorragende Methode zur Differenzierung von unklaren Synkopen und zur Verlaufskontrolle nach Einleitung einer Therapie. Sie hat sich auch im Kindesalter bewährt und ist trotz des hohen personellen Aufwandes eine schnelle und zuverlässige Methode. Dargestellt werden die Indikation, der Untersuchungsablauf, zusätzliche Untersuchungsmethoden wie die transkranielle Doppler-Sonographie sowie Reaktionsmuster unter der Kipptischuntersuchung und Möglichkeiten der Therapie bei der neurokardiogenen Synkope.
Abstract
Tilt table testing is a well approached examination for differentiating unexplained syncope and controll trial after therapy. It is evaluated at children and is fast and reliable in spite of high personality effort. We present the indication of examination, course of examination, additional procedures like transcranial doppler sonography, reaction models during the tilt table examination and treatment features for neurocardiogenic syncope.
Schlüsselwörter
Kipptisch - Synkope - neurokardiogen
Key words
Tilt table - syncope - neurocardiogenic
Literatur
-
1
Alehan D, Celiker A, Özme S.
Head-up tilt test: a highly sensitive, specific test for children with unexplained syncope.
Pediatr Cardiol.
1996;
17
86-90
-
2
Ammirati F, Colivicchi F, Velardi A, Santini M.
Prevalence and correlates of syncope-related traumatic injuries in tilt-induced vasovagal syncope.
Ital Heart J.
2001;
2
38-41
-
3
Baron-Esquivias G, Pedrote A, Cayuela A, Valle J I, Fernandez J M, Estepa M J, Martinez-Morentin E, Navarro M, Burgos J.
Age and gender differences in basal and isoprenaline protocols for head-up tilt table testing.
Europace.
2000;
3
136-140
-
4
Brignole M, Menozzi C, Gianfranchi L, Lolli G, Bottoni N, Oddone D.
A controlled trial of acute and long-term medical therapy in tilt-induced neurally mediated syncope.
Am J Cardiol.
1992;
70
339-342
-
5
Day S V, Cook E F, Funkenstein H, Goldman L.
Evaluation and outcome of emergency room patients with transient loss of consciousness.
Am J Med.
1982;
73
15-23
-
6
Deal B J, Strieper M, Scagliotti D, Hulse E, Auld D, Campbell R, Strasburger J F, Woodrow Benson D.
The medical therapy of cardioinhibitory syncope in pediatric patients.
Pacing Clin Electrophysiol.
1997;
20
1759-1761
-
7
Discroll D J, Jacobsen S J, Porter C J, Wollan P C.
Syncope in children and adolescents.
Am J Coll Cardiol.
1997;
29
1039-1045
-
8
Eberhardt H, Fölsing R, Herterich R, Letzgus A.
Wertigkeit der transkraniellen Dopplersonographie in der Kipptischuntersuchung bei Kindern.
Ultraschall in Med.
2002;
23
379-382
-
9
Eiris-Punal J, Rodriguez-Nunez A, Fernandez-Martinez N, Fuster M, Castro-Gago M, Martinon H M.
Usefulness of head-upright tilt test for distinguishing syncope and epilepsy in children.
Epilepsia.
2001;
42
709-713
-
10
Fredmann C S, Biermann K M, Patel V, Uppstrom E L, Auer A I.
Transcranial Doppler ultrasonography during head-upright tilt-table testing.
Ann Intern Med.
1995;
23
848-849
-
11
Fitzpatrick A P, Theodorakis G, Vardas P, Sutton R.
Methodology of head-up tilt table testing in patients with unexplained syncope.
J Am Coll Cardiol.
1991;
17
125-130
-
12
Grossi D, Nozzoli C, Roca M E, Santostasi R, Simone E.
Head-up tilt for triggering and diagnosing syncope.
Neurol.
1987;
2
457-464
-
13
Grubb B P, Gerad G, Roush K, Temesy-Armos P, Montford P, Elliot L, Hahn H, Brewster P.
Cerebral vasoconstriction during head upright tilt induced syncope: a paradoxic and unexpected response.
Circulation.
1991;
84
1157-1164
-
14
Grubb B P, Orecchio E, Kurczynski T W.
Head-upright tilt table testing in evaluation of recurrent syncope.
Pediatr Neurol.
1992;
8
423-427
-
15
Grubb B P, Temesy-Armos P, Moore J, Wolfe D, Hahn H, Elliot L.
The use of head-upright tilt table testing in evaluation and management of syncope in children and adolescents.
Pacing Clin Electrophysiol.
1992;
15
742-748
-
16
Grubb B P, Samoil D, Kosinski D, Wolfe D, Brewster P, Elliot L, Hahn H.
Cerebral syncope: loss of coonsciousness associated with cerebral vasoconstriction in the absence of systemic hypotension.
Pacing Clin Electrophysiol.
1998;
21
652-658
-
17
Janosik D, Gomez C, Njemanze P.
Abnormalities in cerebral blood flow autoregulation during tilt induced neurocardiogenic syncope.
Pacing Clin Electrophysiol.
1992;
15
592
-
18
Kapoor W N, Brant N.
Evaluation of syncope by upright tilt testing with isoproterenol: a nonspecific test.
Am Intern Med.
1992;
116
358-363
-
19
Karas B, Grubb B P, Boehm K, Kip K.
The Postural Orthostatic Tachycardia Syndrome: A potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents.
Pacing Clin Electrophysiol.
2000;
23
344-351
-
20
Kenny R A, O'Shea D, Parry S W.
The Newcastle protocols for head-up tilt table testing in the diagnosis of vasovagal syncope, carotid sinus hypersensivity, and related disorders.
Heart.
2000;
83
564-569
-
21
Kouakam C, Vaksmann G, Pachy E, Lacroix D, Rey C, Kacet S.
Long-term follow-up of children and adolescents with syncope.
Eur Heart J.
2001;
22
1618-1625
-
22
Levine M M.
Neurally Mediated Syncope in Children: Results of Tilt Testing, Treatment, and Long-Term Follow-Up.
Pediatr Cardiol.
1999;
20
331-335
-
23
Lewis D A, Dhala A.
Syncope in the pediatric patient. The cardiologist's Perspective.
Pediatr Clin North Am.
1999;
46
205-219
-
24
Li H, Weitzel M, Easley A, Barrington W, Windle J.
Potential risk of vasovagal syncope for motor vehicle driving.
Am J Cardiol.
2000;
85
184-186
-
25
Madrid A H, Ortega J, Rebollo J G, Manzano J G, Segovia J G, Sanchez A, Pena G, Moro C.
Lack of efficacy of atenolol for the prevention of neurally mediated syncope in a highly symptomatic population: a prospective, double-blind, randomized and placebo-controlled study.
J Am Coll Cardiol.
2001;
37
554-559
-
26
Mahanonda N, Bhuripanyo K, Kangkagate C, Wansanit K, Kulchot B, Nademanee K, Chaithiraphan S.
Randomized double-blind, placebo-controlled trial of oral atenolol in patients with unexplained syncope and positive upright tilt table test results.
Am Heart J.
1995;
130
1250-1253
-
27
Moak J P, Bailey J J, Makhlouf F T.
Simultaneous Heart Rate and Blood Pressure Variability Analysis: Insight Into Mechanisms Underlying Neurally Mediated Cardiac Syncope in Children.
J Am Coll Cardiol.
2002;
40
1466-1474
-
28
Mtinangi B L, Hainsworth R.
Incresed orthostatic tolerance following moderate exercise training in patients with unexplained syncope.
Heart.
1998;
80
596-600
-
29
Nwosu E A, Rahko P S, Hanson P, Grogan E W.
Hemodynamic and volumetric response of the normal left ventricle to upright tilt testing.
Am Heart J.
1994;
128
106-113
-
30
O'Marcaigh A S, MacLellan-Tobert S G, Porter C J.
Tilt-table testing and oral metoprolol therapy in young patients with unexplained syncope.
Pediatrics.
1994;
93
278-283
-
31
Perry J C, Garson A.
The child with recurrent syncope: autonomic function testing and beta-ardenergic hypersensitivity.
J Am Coll Cardiol.
1991;
17
1168-1171
-
32
Reybouck T, Heidbuchel H, van de Werf F, Ector H.
Tilt training: treatment for malignant and recurrent neurocardiogenic syncope.
Pacing Clin Electrophysiol.
2000;
23
493-498
-
33
Rodriguez R A, Snider K, Cornel G, Teixeira O H.
Cerebral blood flow velocity during tilt table test for pediatric syncope.
Pediatrics.
1999;
104
237-242
-
34
Rodriguez-Nun˜ez A, Couceiro J, Alonso C, Eiris J, Fuster M, Sanchez L, Martinon J M.
Cerebral oxygenation in children with syncope during head-upright tilt test.
Pediatr Cardiol.
1997;
18
406-409
-
35
Rodriguez-Núñez A, Fernández-Cebrián S, Pérez-Muñuzuri A, Martinón-Torres F, Eiris-Puñal J, Martinón-Sánchez J M.
Cerebral syncope in children.
J Pediatr.
2000;
136
542-544
-
36
Roul G, Riehl-Aleil V, Germain P, Bareiss P.
Neurohormonal Profile Before and After β-Blockade in Patients with Neurocardiogenic Syncope.
Pacing Clin Electrophysiol.
1999;
22
1020-1030
-
37
Ruiz G A, Madoery C, Arnaldo F, Menendez C, Tentori M C.
Frequency-Domain Analysis of Heart Rate Variability During Positive and Negative Head-Up Tilt Test: Importance of Age.
Pacing Clin Electrophysiol.
2000;
23
325-332
-
38
Salim M A, Ware L E, Barnard M, Alpert B S, DiSessa T G.
Syncope Recurrence in Children: Relation to Tilt-test Results.
Pediatrics.
1998;
102
924-936
-
39
Saltin B, Blomqvist G, Mitchell J H, Johnson R L.
Responses to exercise after bed rest and after training.
Circulation.
1968;
37/38
(suppl 7)
1-78
-
40
Samoil D, Grubb B P.
Vasovagal (neurally-mediated) syncope. Pathophysiology, diagnosis and therapeutic approach.
Eur J Cardiac Pacing Electrophysiol.
1992;
4
234-241
-
41
Samoil D, Grubb B P, Kip K, Kosinski D J.
Head-upright tilt table testing in children with unexplained syncope.
Pediatrics.
1993;
92
426-430
-
42
Scott W A, Pongiglione G, Bromberg B I, Schaffer M S, Deal B J, Fish F A, Dick F M.
Randomized comparison of atenolol and fludrocortisone acetat in the treatment of pediatric neurally mediated syncope.
Am J Cardiol.
1995;
76
400-402
-
43
Seifer C M, Kenny R A.
Head-up tilt testing in children.
Eur Heart J.
2001;
22
1968-1971
-
44
Stein K M, Slotwiner D J, Mittal S, Schreiner M, Markowitz S M, Lermann B B.
Formal analysis of the optimal duration oft tilt testing for the diagnosis of neurally mediated syncope.
Am Heart J.
2001;
141
282-288
-
45
Sung R YT, Yu C W, Ng E, Du Z D, Tomlinson B, Tam M SC.
Head-up tilt test without intravascular cannulation in children and adolescents.
Int J Cardiol.
2001;
80
69-76
-
46
Thoren P.
Characteristics of left ventricular receptors with nonmedullated vagal afferents in cats.
Clin Res.
1977;
40
415-421
-
47
Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick A P.
Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause.
J Am Coll Cardiol.
2000;
36
181-184
-
48
Zaidi A, Benitez D, Gaydecki P A, Vohra A, Fitzpatrick A P.
Haemodynamic effects of increasing angle of head up tilt.
Heart.
2000;
83
(2)
181-184
Dr. Heinrich Eberhardt
Universitätskinderklinik Marburg
Deutschhausstr. 12
35037 Marburg
Telefon: +49/6421/62667
Fax: +49/6421/2868970
eMail: heieb@ngi.de
