Hi dr. Diana. Thank you so much for your reply. I had a tilt table test done and just got the results yesterday. Before the tilt table test I had two echocardiograms which showed a normal heart with no diseases. And several EKGs that were all normal as well. I have to say the tilt table test report is very confusing for me. The diagnosis says syncope. I have not fainted since this whole thing started. When I was in the laying down position it revealed normal sinus rhythm with a heart rate of 75 beats per minute. With no other abnormalities noted.
Evaluation of parasympathetic autonomic function was performed by measuring heart rate variability during paced breathing. heart rate variability during of Valsalva maneuver and heart rate variability autonomic function and assessment for orthostatic hypertension was performed by measuring the beat to beat blood pressure response during a Valsalva maneuver in the beat to beat blood pressure response during a five minute passive upright tilt. Measures of heart rate variability with deep respiration test of cardiac vagal function where in the normal range. There was a normal heart rate response to a Valsalva maneuver the blood pressure sympathetic vasomotor response and phase 2 of the Valsalva maneuver was normal.. there was an exaggerated postural tachycardia on active standing the highest recorded heart rate was 148 beats per minute from a baseline of 91 after 5 minutes of standing. The patient reported palpitations and pressure in the head. There was a transient blood pressure fall with a recovery on active standing. The lowest recorded blood pressure was 81/39. From a baseline of 104 over 57 after two minutes of standing. There was a normal hemodynamic response during the first 5 minutes of passive tilt. It says measures of parasympathetic and sympathetic adrenergic and sympathetic cholinergic function are in the normal range. This is the part I don’t get it. Postural tachycardia as seen on the active standing in tilt table test is a nonspecific finding. And exaggerated postural tachycardia has been associated with a mild or early autonomic neuropathy. Neuropathy that involves the distal vasculature sparing the cardiac intervation, cardiovascular deconditioning, cardiac beta adrenoreceptor supersensitivity, mitral valve prolapse, fever, and volume depletion. We have also seen this response in patients diagnosed with chronic fatigue syndrome. Postural tachycardia maybe a provocative factor for neural ii-mediated syncope. Although syncope was not seen in the study clinical correlation is required.