Síncope, presíncope y mareos en el adulto mayor: utilidad de la prueba de inclinación en el proceso diagnóstico

Objectives: the primary aim of this study was to evaluate the usefulness of the head-up tilt (HUT) test in the diagnosis of patients with history of syncope, presyncope or dizziness of unknown origin. A secondary aim was to describe the hemodynamic pattern during the HUT test in order to subclassify patients into distinct groups. Material and methods: patients aged more than 60 years old with a history of syncope or dizziness consecutively attending the arrhythmia unit in our center. The development of hemodynamic alterations and/or symptom reproduction was determined through the HUT test. Selected patients underwent carotid sinus massage. Results: we studied 141 patients. The mean age and standard deviation was 74 ± 7.1 years (range, 61-93); 72 (51.1%) were women. Of 104 patients with a history of syncope, 89 had had two or more episodes. The HUT test was positive for symptoms in 59/141 (41.8%) patients: 36 developed dizziness and 23 syncope. Eighty-two patients showed no symptoms, but hemodynamic abnormalities were observed in 9/82 (11%). A typical hemodynamic pattern was identified in 87/141 (61.7%): 63 patients developed orthostatic hypotension, and 24 patients developed neurally mediated syncope. Conclusions: the HUT test gave a probable diagnosis in two-thirds of the patients studied (typical hemodynamic pattern plus an abnormal test) and allowed hemodynamic changes to be measured and analyzed with a view of guiding treatment. This test was highly useful in patients with syncope and symptoms related to orthostatic stress.