Rivasi Giulia, Rafanelli Martina, Ungar Andrea
Syncope Unit, Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Syncope Unit, Geriatric Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
Am J Cardiol. 2018 Aug 1;122(3):517-520. doi: 10.1016/j.amjcard.2018.04.033. Epub 2018 May 1.
Thirty years ago Tilt Testing (TT) was described as a tool in the diagnostic work-up of vasovagal syncope; after its initial success, some flaws have become evident. The concept of hypotensive susceptibility has provided the test a new relevance, shifting from diagnosis only, to therapeutic management. Carotid Sinus Massage (CSM) was introduced at the beginning of the XX century; the technique has evolved over years, whereas the concept of carotid sinus syndrome (CSS) has remained unchanged and uncontested for more than half a century. Nowadays, CSS is a matter of debate, with new classifications and criteria coming on the scene. Recently, a common central etiological mechanism has been hypothesized for reflex syncope, manifesting as CSS, vasovagal syncope or both. In this context, TT and CSM acquire an important role in clinical practice, being essential for a complete diagnosis and treatment. Recalling their historical background, the present paper illustrates an actual interpretation of TT and CSM.
三十年前，倾斜试验（TT）被描述为血管迷走性晕厥诊断检查中的一种工具；在其最初取得成功后，一些缺陷变得明显起来。低血压易感性的概念为该测试赋予了新的意义，从仅用于诊断转变为用于治疗管理。颈动脉窦按摩（CSM）于二十世纪初被引入；多年来该技术不断发展，而颈动脉窦综合征（CSS）的概念在半个多世纪里一直保持不变且未受到质疑。如今，CSS成为了一个有争议的问题，新的分类和标准不断出现。最近，有人提出反射性晕厥存在一个共同的中心病因机制，表现为CSS、血管迷走性晕厥或两者皆有。在此背景下，TT和CSM在临床实践中发挥着重要作用，对于完整的诊断和治疗至关重要。回顾它们的历史背景，本文阐述了对TT和CSM的实际解读。
