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Transcranial Doppler Ultrasonography during Head-Upright Tilt-Table Testing

Carey S. Fredman, MD; Kurt M. Biermann, RN, BSN; Vipool Patel, MD; Erica L. Uppstrom, MD; and Arthur I. Auer, MD
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From St. John's Mercy Heart Center and Christian Northeast Hospital, St. Louis, Missouri. Acknowledgments: The authors thank Katheryne Dieckmann and Rebecca Nappier for technical assistance and Nancy La Chance for secretarial help in preparing the manuscript. Requests for Reprints: Carey S. Fredman, MD, FACC, Electrophysiology Laboratory and Pacemaker Services, St. John's Mercy Heart Center, 621 South New Ballas Road, #3005-B, St. Louis, MO 63141. Current Author Addresses: Dr. Fredman: Electrophysiology Laboratory and Pacemaker Services, St. John's Mercy Heart Center, 621 South New Ballas Road, #3005-B, St. Louis, MO 63141.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(11):848-849. doi:10.7326/0003-4819-123-11-199512010-00007
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Head-upright tilt-table testing is often used to support the diagnosis of vasovagally mediated syncope [14]. Studies that have looked at the hemodynamic changes that occur during head-upright tilt-table testing [1] have shown that positive test results are often associated with both systemic hypotension and bradycardia and that hypotension almost always precedes bradycardia. In a minority of positive tilt-table tests, syncope results from hypotension alone.

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Figure 1.
Cerebral blood flow velocity (CBF), heart rate (HR), pulsatility index (PI), and systolic and diastolic blood pressure (BP) response during head-upright tilt-table testing.

Heart rate is measured in beats/min; blood pressure is measured in mm Hg; time is measured in minutes; and cerebral blood flow is measured in cm/s.

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