Malign Asystole During Head-up Tilt Test: A Case Report and Overview

CASE REPORT, Jan 2011, VOL I ISSUE III, ISSN 2042-4884
10.5083/ejcm.20424884.22 , Cite or Link Using DOI
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Yahya Islamoglu, MD, Musa Cakici, MD, Hayri Alici, MD & Vedat Davutoglu, MD


The head-up tilt (HUT) test is a standard diagnostic test that is widely accepted in the evaluation of patients with recurrent syncope of unknown etiology. Prolonged asystole during the HUT test is rarely encountered in patients with neurocardiogenic syncope. The incidence of prolonged asystole in patients with neurocardiogenic syncope is 18% (>3 seconds) and 9.1% (>5 seconds) (1-3). According to our knowledge, there have been few reports related to prolonged asystole longer than 30 seconds during the HUT test (4-8). Asystole lasting for approximately 30 seconds during a HUT test was observed in the present case, which was presented due to its rarity, and we review the importance and prognostic significance of prolonged asystole during HUT.


A 37-year-old female patient was admitted to our clinic with seven episodes of syncopal attacks within the last year. All syncope attacks had occurred while standing for a long time and each lasted for two to three minutes. She described no prodromal symptoms prior to the syncopal attacks. She did not experience any muscle contractions or urinary incontinence during syncope. Her medical history was unremarkable.

Her family history did not reveal sudden death or syncopal attacks. Her physical examination, chest radiography, electrocardiography, complete blood count, thyroid function, serum electrolyte levels, echocardiography, exercise test and neurologic examination were normal. Thus, it was decided that the HUT test should be performed. Prior to performing a HUT test, her blood pressure was 110/70 mmHg and the heart rate was 80/minute. The HUT test was performed at an angle of 75°, and nitroglycerin was administered sublingually at the 30th minute of the test. Three minutes later, asystole occurred following hypotension and bradycardia...