Questions About My Tilt Testing

[lmt033167]

For a dx of NCS (Neurocardiogenic Syncope) are there the same parameters with other ANS issues such as an excessive rise or fall as in bp/hr with PoTS and OI? If so, is it? >30 points like with PoTs? <20points like with OI?

Also, for proper diagnosis, does that include when there is minimal increase/decrease during the 20 min standing time or does that include when they give the med like Nitro to increase symptoms?

Here's my TTT results; which I've questioned -

BP 126/79 HR 77 - Start

BP 129/87 HR 101 - 20 min

BP 137/71 HR 109 Nitroglycerin given - By minute #4 after Nitro was given, the patient had a syncopal event with no palpable pulse

BP 97/48 HR 78 - supine state

Findings: Profound Sinus Bradycardia; Classic symptoms of neurocardiogenic syncope with cardioinhibitory and vasodepressor responses (NCS & OI)

My questions are related to why I was dx with NCS when my bp stayed the same during the 20 minutes, but I wasn't dx with PoTS even though my HR went up 32 pts because there are different reasons for syncope.

I've suspected I had HOCM (obstructive HCM) which I finally found out yes I was dx with this back in August 2009 and just wasn't told. Patients with HCM/HOCM would react this way to Nitro and that would be an expected outcome; however my dr's said they had no clue why I reacted the way I did but that was days before I had a cardiac cath that dx the HOCM.

I called Mayo Clinic here in Fl to see one of the heart specialists so I can get a 2nd opinion, what questions should I ask about NCS/OI so I can make sure to ask when I go.

[sj75]

Im afraid i cant help with any answers but just wanted to say i find the results very interesting.

The result of having the nitro is shocking! but makes perfect sense. It would have been really interesting to see though what your bp and pulse would have continued to do without the nitro. on my ttt the bp and pulse kept going up and up until right at the end.x

[lmt033167]

Thanks for the reply sj75 I've questioned this since I had it done and can't find the answer. I wonder what normal protocol is? does the 20 minute time limit sound right for a tilt test? some interesting things I've found looking for TTT protocol -

Physicians should question the correlation between clinically spontaneous and induced results. It seems in the case of vasovagal syncope, it seems to be clear that they are equivalent.

My father in law had one done a few months before me and they gave him 5 doses of Nitro and he wouldn't pass; out even though he had fainted and was put in the hospital to find out why (he has CAD and had bypass many years ago).

I don't think this is NCS - I'm going to a new dr June 27 so i'm going to ask...and def ask Mayo when i go for my heart realated stuff.

I've had complete syncope since age 9, with and without arrhythmia's at the time of syncope but the majority of the time it's while I'm doing something... like fainting in school walking to class; during PE, summer camp when I was 9 was the first real episode I remember - I had taken a shower gotten ready and went to go back to my room and woke up being carried to the office and being sent to the ER.