Tilt-Testing for Syncope: When to Refer and When It Can Make a Difference
Effectively differentiating between potentially life-threatening causes of syncope and more benign causes requires careful evaluation. Tilt-testing is used variably across cardiovascular units around the world. Its sensitivity and specificity in identifying causes for syncope is debated, yet it can provide important diagnostic information if performed and interpreted skilfully and has a role in guiding therapy. We discuss how it is performed, how to interpret the results, and when it can make a difference to the investigation and treatment of patients with syncope.
P Boon Lim
Key Learning Objectives
- Explain how to perform a tilt-test and what is involved
- Describe how to interpret the results
- Discuss the indications and appropriate cases to refer
- Explain when it can make a difference in making a diagnosis
- Explain when it can make a difference in guiding therapy
- General Cardiology
- General Medicine
- General Practice
- Geriatric Medicine
P Boon Lim
Dr P Boon Lim is a Cardiologist and electrophysiologisy specialising in heart rhythm disturbances, pacing and syncope at Imperial College Healthcare NHS Trust and a senior lecturer at Imperial College London. He graduated from Cambridge University with a double first-class honours degree and completed his cardiology training in Oxford and North West London Hospitals. He pursued a PhD at Imperial College London studying the role of the autonomic nervous system in arrhythmias.
Dr Lim has a strong interest in syncope and leads the well-regarded Imperial Syncope Diagnostic Unit, a heavy volume speciallist tertiary syncope service. He leads more than 800 tilts a year and actively engages in research to understand mechanisms of syncope and understanding the best treatment strategies for patients with debilitating syncope.
Dr Lim was the UK reviewer for the European Society of Cardiology Guidelines for Syncope and is an executive member of the Syncope Trust and Reflec Anoxic Seizures (STARS) Charity, providing guidance and lectures to patients and staff members to help improve the understanding and management of patients with syncope. He also set up the Syncope Education website, www.stopfainting.com, a free resource for patients and physicians alike.
Dr Afzal Sohaib is a Consultant Cardiologist at the Bart's Heart Centre in London and Barking, Havering, and Redbridge University Hospitals NHS Trust. Having completed his medical training at University College London, Dr Sohaib undertook training as a Cardiology registrar at centres in North West London including Imperial College Healthcare NHS Trust and Royal Brompton & Harefield Hospitals NHS Trust. His main research interest lies in cardiac electrophysiology and devices, having also completed a PhD studying how biventricular pacemakers deliver benefits in heart failure.
Dr Sohaib has an interest in improving teaching and training in cardiology and has served on the Specialty Advisory Committee for Cardiovascular Medicine at the Royal College of Physicians which designs and oversees the delivery of cardiology training in the UK. Dr Afzal Sohaib is currently on the ESC Cardiologists' of Tomorrow Nucleus initiative, has directed the annual British Junior Cardiologists' Association (BJCA) meeting, and is involved in designing the programme for the ESC Congress.