© 2000 by European Society of Cardiology
SYNCOPE
‘The Italian Protocol’: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope
1Cardiology Division, Ospedale Santa Maria Annunziata Firenze, Italy; 2Cardiology Division, Ospedale Civile Cento, Italy; 3Department of Cardiology, Ospedale San Filippo Neri Roma, Italy; 4Arrhythmologic Centre, Ospedali Riuniti Lavagna, Italy; 5Department of Cardiology, Ospedale San Pietro Igneo Fucecchio, Italy; 6Department of Cardiology, Ospedale Valduce Como, Italy; 7Department of Cardiology, Ospedale S Maria Nuova Reggio Emilia, Italy; 8Cardiology Division, Ospedale Civile Umberto I Mestre, Italy; 9Department of Cardiology, Royal Brompton Hospital London, U.K.
Abstract
Head-up tilt testing potentiated by sublingual nitroglycerin (NTG), advocated by an Italian group, is a simple and safe but still not a standardized, diagnostic tool for the investigation of syncope. In fact, owing to its rapid spread, the original protocol received, often arbitrarily, many subsequent modifications. We now define the best methodology of the test on strictly evidence-based criteria as: stabilization phase of 5 min in the supine position;passive phase of 20 min at a tilt angle of 60 degrees;provocation phase of further 15 min after 400 µg NTG sublingual spray. Test interruption is made when the protocol is completed in the absence of symptoms, or there is occurrence of syncope, or occurrence of progressive (>5 min) orthostatic hypotension. We intend that this protocol, named by us as ‘The Italian Protocol’, will be accepted as the standard methodology of the tilt test potentiated by sublingual nitrates.
Key Words: Syncope, tilt testing, nitrates
Correspondence: Angelo Bartoletti MD, Costa dei Magnoli 28 50125, Florence, Italy. E-mail: bartoletti{at}dada.it.
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