Gynecology
The obstetrics and gynecology department of the Federal State Budgetary Institution "CDC with a polyclinic" offers unique modern capabilities for comprehensive diagnosis and treatment of all types of obstetric and gynecological pathologies based on the latest modern technologies for diagnosis, prevention and treatment.
The department's doctors provide consultations, diagnostics and outpatient visits to patients, and are proficient in ultrasound diagnostics and colposcopy.
The gynecology department carries out: a set of preventive and therapeutic measures for pregnancy planning and gestation, diagnosis and treatment of all types of gynecological diseases, selection of modern contraceptive methods, provision of emergency care for acute obstetric and gynecological pathologies.
Neurology
The Department of Neurology of the Federal State Budgetary Institution "CDC with Clinic" provides a full range of examinations and treatment of neurological patients that meets international quality standards and international clinical and therapeutic practices.
In order to provide high-quality medical care, the department is staffed not only with highly qualified neurological doctors, but also with specialists providing medical care across the entire spectrum of psychotherapeutic, psychiatric, neurophysiological diseases, including child neurology, as well as nurses with the highest or first qualification category .
ENT otorhinolaryngology
The Department of Otorhinolaryngology provides comprehensive diagnosis and treatment of diseases of the ENT organs of adults and children.
The department employs highly qualified specialists. The department is equipped with modern certified equipment, which allows for high-quality diagnosis and treatment of ENT diseases.
Ophthalmology
The ophthalmology department is equipped with diagnostic equipment in accordance with modern world standards. This allows for a comprehensive examination of patients in a minimum number of visits.
Highly qualified ophthalmologists provide consultations to adults and children with problems of any degree of complexity.
Most examinations of the organ of vision and visual analyzer are carried out non-contact, which significantly reduces the risk of any inflammatory complications and is comfortable for the patient.
Urology
The urology department of the Federal State Budgetary Institution "CDC with a polyclinic" provides complete diagnostics and qualified comprehensive treatment of patients with diseases of the genitourinary system and andrological pathology using the most modern instrumental examination methods and advanced equipment.
Surgery
The surgical department of the “CDC with a polyclinic” is equipped with modern diagnostic equipment, which allows for a detailed multilateral examination of patients, both adults and children, in a minimum number of visits.
In our surgery center, patients are received by specialist doctors with extensive experience, doctors of the highest qualification category, candidates of medical sciences in the following areas: surgeon, proctologist, vascular surgeon, oncologist, mammologist.
The diagnostic equipment of the CDC on Krestovsky allows us to carry out all the necessary sonographic, radiographic and endoscopic procedures, as well as a range of laboratory tests (from general clinical studies to the diagnosis of colon tumors).
Traumatology and orthopedics
The main area of work of the traumatology department of the CDC with Clinic is the treatment of pathologies of the musculoskeletal system associated with sports and physical activity.
Along with conservative methods of treating conditions associated with acute injuries or chronic overloads, as well as degenerative changes in joints and tissues of the extremities, minimally invasive surgical methods are widely used, which makes it possible to achieve recovery in a short time.
The department's doctors work in accordance with international standards for the treatment of injuries and diseases of the musculoskeletal system using modern rehabilitation programs, as well as advanced arthroscopic and precision techniques.
Dentistry
The dental department of the Federal State Budgetary Institution "CDC with a polyclinic" offers unique opportunities for comprehensive diagnostics and planning of individual and family dental health programs based on the latest digital computer technologies for the diagnosis, prevention and treatment of dental diseases.
A comprehensive program of clinical examination is aimed at creating an individual dental passport.
Hospital
The hospital of the Federal State Budgetary Institution "CDC with a polyclinic" includes two operating rooms, an intensive care ward and comfortable single and double wards. Hospital patients are assigned responsible doctors who supervise the patient until discharge. Treatments and nursing care are provided 24 hours a day by qualified nurses with many years of experience.
Depending on the complexity and duration of the surgical intervention, postoperative observation is carried out in the intensive care ward or in the ward of a short-stay hospital. In the hospital of our center, you can undergo a full examination of the body, as well as conservative treatment of existing diseases.
Day hospital
The day hospital of the Federal State Budgetary Institution "CDC with a polyclinic" includes one four-bed ward, equipped with oxygen access, a sanitary room, a shower, a patient condition monitoring and emergency notification system. Hospital patients are assigned responsible doctors who supervise the patient until discharge. Treatments and nursing care are provided 24 hours a day by qualified nurses with many years of experience.
Depending on the complexity and duration of the surgical intervention, postoperative observation, monitoring of patients who have undergone anesthesia and require intravenous infusions. In the day hospital of our center, you can undergo a full examination of the body, as well as carry out conservative treatment of existing diseases or its adjustment, depending on the existing diseases.
Ambulance and emergency medical service
The emergency care teams of the Federal State Budgetary Institution "CDC with a polyclinic" consist of qualified doctors and paramedics with many years of experience.
Medical assistance vehicles are equipped with air conditioning, autonomous interior heating systems and converters, and are also equipped with unique stretchers and special gurneys developed according to an individual project.
When calling the doctors of our teams, there is the possibility of hospitalization in the hospital of the Federal State Budgetary Institution "CDC with a polyclinic" and other hospitals in the city for further examination and treatment, taking into account the condition and wishes of the patient and his relatives. Medical assistance is provided around the clock in St. Petersburg, the Leningrad region and the entire North-Western region.
First-aid room
The pre-medical reception room at the Federal State Budgetary Institution “CDC with a polyclinic” allows you to regulate the flow of patients and provide pre-hospital emergency care to the clinic’s clients. If the patient’s well-being does not require consultation with a doctor, he can visit the pre-medical office to monitor his health, be examined before tests, and complete a medical examination program.
As part of the pre-medical appointment, all patients of the center undergo a nursing examination, the results of which are recorded in the Pre-medical Protocol. The pre-medical protocol is drawn up in the patient’s outpatient record and entered into the electronic MIS system “ORBIS”, which allows the doctor to have a complete picture of the patient’s clinical condition already at the first appointment.
Telemedicine
Dear patients!
link.
The total number of our specialized doctors and qualified nursing staff exceeds 300 people, which allows us to find consultative solutions to any patient complaints and achieve the most effective treatment for people who contact us.
Prevention
The Federal State Budgetary Institution “Consultative and Diagnostic Center with a Clinic” provides a number of treatment and preventive services aimed at identifying health problems in patients, preventing the emergence and spread of various diseases, as well as preserving and promoting health.
As part of the provision of preventive and advisory health care to patients, the medical center regularly holds public events where clinic specialists inform the population about common diseases, habits and risk factors that negatively affect their health, as well as methods for combating and preventing diseases.
Diagnostics
The Federal State Budgetary Institution "CDC with a polyclinic" has unique diagnostic capabilities that allow us to conduct examinations for any type of pathology in the shortest possible time and with maximum comfort for our patients.
Our medical center performs magnetic resonance imaging (MRI), multislice computed tomography (MSCT), digital radiography and mammography, and osteodensitometry. The Department of Functional Diagnostics conducts ultrasound examinations of all organs and systems of the body, and applies the entire range of functional diagnostic methods in cardiology and neurology. The Endoscopy Department carries out all modern types of therapeutic and diagnostic endoscopic examinations. Our own clinical diagnostic laboratory performs all types of tests.
Treatment
Rehabilitation
Hospital
In the hospital of our center, you can undergo a full examination of the body, as well as conservative treatment of existing diseases. Hospital patients are assigned responsible doctors who supervise the patient until discharge. Treatments and nursing care are provided 24 hours a day by qualified nurses with many years of experience.
Sports medicine
The Department of Sports Medicine of the Federal State Budgetary Institution “Consultative and Diagnostic Center with a Clinic” is intended to provide specialized medical care to athletes, coaches, veterans and disabled sportsmen. Medical care is provided in the following profiles: consultative and diagnostic, outpatient, inpatient replacement activities; rehabilitation of patients with damage to the musculoskeletal system and peripheral nervous system; conducting medical examinations for members of national teams and students of educational institutions of sports training; issuing certificates of admission to sports and exercise therapy. In addition, medical support services for sporting events are provided on a commercial basis.
Thanks to such close communication, the doctor has the opportunity not only to treat diseases as a whole, but also to develop an individual approach to each patient, and to draw up a program for the prevention of diseases, including hereditary ones.
The Family Medicine Department offers ample opportunities to conduct a comprehensive examination of the body, including express diagnostics, which allows not only to identify diseases, but also to prevent their occurrence.
Pediatric medicine
Experienced pediatricians of the Federal State Budgetary Institution “CDC with a polyclinic” take comprehensive care of the child’s health.
The center’s specialists carry out disease prevention and prevention, monitor all age-related changes, conduct consultations and diagnostic appointments, outpatient treatment, vaccinations and clinical studies using advanced certified equipment.
Your child will receive qualified care from specialized specialists (ENT specialist, ophthalmologist, traumatologist-orthopedist, neurologist), an individual plan of treatment and rehabilitation measures after illness. With us you can also issue certificates of incapacity for child care and certificates for children for submission to government agencies.
Pharmacy
The center's pharmacy offers a wide selection of medicines and exclusive health products.
The pharmacy has an automated system for searching and dispensing the necessary medications, which reduces the time for issuing one package of medicines to 5–9 seconds.
Experienced pharmacists will advise on the availability of necessary medications, and will also accept orders for drugs and medical products that may not be in stock.
Telemedicine
Dear patients!
We strive to become more accessible to you, and now the Federal State Budgetary Institution “CDC with Clinic” has a new service - telemedicine consultation.
Now you have the opportunity:
1) Communicate with your doctor remotely: quickly and easily contact a doctor online without getting out of bed.
2) Send the results of tests and examinations and receive their transcript from the attending physician at a time convenient for you.
3) The doctor monitors the course of the disease over time, adjusts the treatment if necessary and relieves your anxiety and fears about your condition, and all this happens online!
In order to use the telemedicine consultation service, you need:
1) See a doctor for an in-person visit.
2) Sign the informed consent and agreement for the provision of telemedicine consultations at the reception desk.
3) Sign up for an online consultation with a doctor or at the reception.
4) At the appointed time in any convenient place, have a PC or smartphone (tablet) with Internet access.
You can view the offer agreement for telemedicine services using the link.
Blood pressure causes trouble not only when it rises, but also when it becomes low. And among us there are no less hypotensive people than hypertensive people...
Low blood pressure (hypotension) or scientifically arterial hypotension is characterized by low pressure, where the upper pressure is below 100 mm H.S., and the lower pressure drops below 50 mm H.S.
Many of us live with fairly low blood pressure levels without even realizing it. Such a status does not entail any particular inconvenience for people. Hypotension turns from a condition into a disease only when a person develops very specific complaints, such as weakness, dizziness when standing up suddenly, and situational fainting.
Women suffer from hypotension more often than men. Young, thin representatives of the fairer sex with pale skin are most likely to be hypotensive. The tendency to such a pathology is inherent in the nature of the weaker sex - different hormones, different regulation of blood circulation, lower muscle mass, low physical fitness.
Nevertheless, hypotension It can happen in men too. This disease can be the result of large blood loss, appear after severe burns or as a result of heart failure. In addition, hypotension can develop according to the principle “we treat one thing, and cripple the other,” if you regularly take specific medications. Whatever the cause of the disease, it must be supported by facts. And the familiar tonometer and TIL test help the doctor do this.
“To perform a TIL test, a person is placed on a special rotating table, with which you can create the desired angle of inclination in both directions. Thus, a person is in a state of passive change in body position. Such a test lasts, according to the protocol, up to 45 minutes,”- says Alexandra Conradi, head of the V.A. Almazov Center for Heart, Blood and Endocrinology.
If a person has to suddenly change his body position on his own, a natural muscle contraction occurs, which prevents a decrease in pressure. But in the TIL test, a person does not need to make any effort, and therefore the indicators are more clear.
In rare cases, the disease can be severe, even leading to immobilization of the human body. In such cases, the patient is prescribed medication.
“Hypotension is a milder disease than hypertension. But here we also need to figure it out. If this is a symptom of some serious illness, then it can be dangerous for the body. But if it’s just primary hypotension, then it’s not so scary,” - says Dr. Nonna, academician of the Russian Academy of Natural Sciences, creator of the “Doctor Nonna” drugs.
Typically, hypotension goes away on its own with age.
Headache
One of the main manifestations of hypotension is headache. The nature of hypotensive headaches can vary. Most often it is a dull and pressing pain, but it can also be paroxysmal, throbbing in nature. Along with the headache, there may be an increase in heart rate and a feeling of cold to the point of trembling. . The main feature of headache with hypotension is the noticeable degree of its severity. Quite often, such pain appears after mental or physical stress, as well as after sleep, especially after daytime sleep.
This kind of pain has no clear localization. It can take over the entire head and occur in different parts of it - frontal, occipital, parietal. The cause of headaches can also be migraine, which can be provoked by low blood pressure. Typically, a headache with hypotension is accompanied by yawning, nausea and even vomiting. In the mechanism of development of headaches with low blood pressure, a key role is played by changes in the tone of the vascular walls.
During an attack of hypotonic headache, a person’s face turns pale - vasoconstriction occurs, but in some cases dilatation (expansion) of the arteries of the head may occur, then the person’s face turns red. The attack may continue for several hours, after which the headache begins to gradually decrease. If a person manages to fall asleep during an attack, then most likely he will wake up without a headache, but general malaise and weakness will remain.
Outside of a headache attack, hypotensive patients feel quite healthy, and it is difficult to identify signs of the disease in them.
How to help yourself
go down blood pressure in hypotensive patients may be in response to changes in atmospheric pressure, high humidity, alcohol intake, overeating and stress.
If you notice that your condition has begun to worsen, try warming your nose, neck, and forehead with a heating pad. If you feel worse, place a heating pad on your chest briefly. If you are at work, make yourself some hot tea, warm your palms, rub your nose. The main remedy for low blood pressure is hot coffee or strong, hot sweet tea with lemon. Sometimes a little cognac or red wine, such as Cahors, helps.
Reader Questions
18 October 2013, 17:25 Hello, please advise, my mother, as prescribed by a cardiologist, takes Lozap+ 12.5 mg. and Coriol 12.5 mlg, for 8 months now (medications were prescribed for life), and today her blood pressure dropped very much, 95/53, although the pulse was 90 beats/m. Maybe you need to take Asparkam or other similar drugs with these medications? Tell me, our cardiologist is on vacation, you are our only hope. Thank you in advance!
Ask a QuestionDoctors do not advise hypotensive patients to go outside with their heads and necks exposed in cold weather. It is better for hypotensive patients to keep their legs and arms warm. After all, the cardiovascular system has to make great efforts to warm the limbs, and this is an additional burden.
Painkillers (citramon) and antispasmodics can also help with headaches, but keep in mind that they can increase dizziness. Therefore, it is better to take them together with vasodilating medications that your doctor will prescribe.
Don't let any changes in the weather worsen your well-being. Be healthy.
Tilt test– diagnosis of the patient’s condition in conditions that provoke fainting to identify the causes of syncope (fainting). The test is carried out on expert-class medical equipment: TASK FORCE Monitor 3040i. The diagnostic system allows for non-invasive monitoring of hemodynamic parameters, assessment of the state of the cardiovascular, autonomic nervous systems and cerebral blood flow.Monitored parameters:
- blood pressure (beat-to-beat measurement);
- stroke volume and cardiac output;
- total peripheral vascular resistance;
- variability of heart rate and blood pressure (spectral analysis);
- baroreflex activity and sensitivity.
Indications for performing a tilt test:
- syncope: diagnosis of neuroreflex syncope in accordance with the recommendations of ESC, ACC, etc.;
- disorders of nervous regulation: early diagnosis and evaluation of results (patients with diabetes mellitus and other diseases associated with neuropathies);
- artificial pacemaker (pacemaker): operation control;
- assessment of the effectiveness of pharmacotherapy based on hemodynamic parameters;
- arterial hypertension: assessment of hemodynamic markers, baroreflex;
- occupational medicine: assessment of professional suitability (resistance to prolonged orthostatic loads);
- sports medicine: testing with load and in training mode.
- Westminster Protocol - detects changes in blood pressure and heart rate during testing (estimated test time is 40 minutes).
- Italian protocol (with pharmacological challenge) - after a short baseline test (time depends on the study protocol), the patient receives a dose of drugs that increase the frequency and strength of heart contractions and causes venodilation.
- unstable angina;
- circulatory failure, high functional class (NYHA);
- arterial hypertension 3 degrees;
- condition after acute cerebrovascular accident (less than 6 months);
- severe respiratory failure;
- acute infectious diseases;
- endocrine diseases in the stage of decompensation (diabetes mellitus);
- mental disorders.
Rules for conducting a tilt test
The test is carried out in a specially equipped room in accordance with regulatory documents and recommendations. Before the test, the patient's informed consent is obtained. The study is carried out, as a rule, in the first half of the day, on an empty stomach, against the background of withdrawal of all cardioactive and psychotropic drugs.The total duration of the test is 60 minutes. Orthostatic load for 40 minutes, pharmacological load (nitrolycerin 400 mcg sublingually), depending on the study protocol.
The term tilt test in cardiology or passive orthostatic test refers to an examination designed to determine the cause of syncope or, simply put, fainting. During the test, the patient is placed on a special bed, which can be tilted at angles of 30-60 degrees with different intensities. This creates conditions that can trigger fainting. Inducing fainting is the goal of this test, as the subject's heart rate is constantly monitored using an ECG, as well as blood oxygen levels and blood pressure.
The tilt test, which is performed in the electrophysiology laboratory, can be considered a diagnostic method necessary for choosing the correct cardiac treatment tactics.
What is a tilt test?
Most often, tilt tests are performed to diagnose syncope in relatively healthy and young patients, and much less often in older patients (only in cases where the diagnosis cannot be established using alternative studies). During this study, conditions are created for maximum venous outflow, which can cause neurocardiogenic (vasovagal) variant of syncope, as a result of which signs and symptoms characteristic of this condition begin to appear: dizziness, nausea, pale skin, bradycardia and arterial hypotension.
The tilt test (passive orthostatic test) is reduced to a sharp change in the horizontal position of the passive body into a vertical one, due to which the subject’s blood flows to the lower part of the body, which causes a drop in pressure in the right parts of the heart. This condition in patients suffering from neurocardiogenic syncope can cause sudden loss of consciousness and hypotension.
Throughout the test, a tonometer and an ECG machine are connected to the patient. The time after which consciousness was lost and the interpretation of ECG data provide information about the state of the cardiovascular, nervous and endocrine systems of a person.
Contraindications
The tilt test has relative contraindications:
- severe coronary pathologies;
- hypertrophic cardiomyopathy;
- severe mitral or aortic stenosis.
Conducting a tilt test
Preparation
If during the test the head must be tilted downwards or to the sides, then in preparation for the procedure the subject must adhere to the following recommendations:
- have with you all prescribed medications and instructions for their dosage;
- after midnight on the eve of the test, do not eat or drink, and take medications necessary for taking with a minimum of water;
- make sure in advance that there is someone to take the subject home after the test;
- put on comfortable clothes, leaving all jewelry at home;
- Patients with diabetes should discuss with their physician the appropriate medications, food, and fluids required prior to testing.
Connected devices
Before the procedure, the nurse prepares the subject’s vein for the possible administration of drugs if necessary, and also helps him tune in to the procedure. The patient is conscious during the test; he just needs to lie quietly, keeping his legs together.
The nurse will connect the sensors of four devices to the patient’s body:
- Pacemaker/defibrillator. Using a patch, two of its plates are attached: one to the back and the other to the patient’s chest.
- Sensors of a device that takes an electrocardiogram and records signals about the heart's work in real time on a paper tape are fixed to the subject's chest using suction cups or on a patch.
- An oximeter is a device for monitoring the oxygen content in the blood; its clip-electrode is connected to the tip of one of the fingers on the hand.
- The tonometer is fixed near the elbow on the shoulder and measures blood pressure during testing.
Step by step process
The procedure usually lasts 1-2 hours, but may end earlier if changes in blood pressure and heart rate, as well as characteristic fainting symptoms, begin to be observed during the test.
- The subject is placed on a mechanized bed, which has a footrest on one side, and is secured in the abdominal area with a belt.
- A needle is inserted into one of the veins in the arm, through which during the test it will be possible to draw blood for analysis or, if necessary, quickly administer the necessary medicinal solutions.
- The patient will then lie in a horizontal position for 15 minutes, after which the table will gradually begin to rotate until it is in a vertical position. In this case, the subject will have a simulated situation as if he were getting up from a lying position. Depending on the purpose of the test, the subject can remain in this position for 5 to 45 minutes.
- When turning the table, the specialist monitors heart rate and blood pressure. The subject in an upright position should remain as still as possible.
- Throughout the test, doctors ask the subject about his well-being. If he feels weak or faint, the table will be immediately returned to a horizontal position.
- Vasovagal syncope is identified by the corresponding symptoms. If none are found, the subject may be given certain medications, such as nitroglycerin or isoproterenol, to induce symptoms of fainting. Depending on the research protocol used, the sensitivity of the test is in the range of 30-80%, and in 10-15% of cases false positive results are observed.
Possible sensations of the subject during the test
During this test, a person may feel the approach of fainting or not feel anything like it. You should not be afraid of losing consciousness during the test - after all, the situation is completely controlled by the doctor and nurse. Sometimes the specialist gives the test subject a drug that causes strong heart palpitations, but after the end of the tilt test it quickly goes away.
Most often, the person being tested can get home independently after the test, but it is preferable for someone to accompany him. After analyzing the results of the tilt test, the doctor can more accurately choose the most effective method of heart treatment, and if doubts remain, he can prescribe other studies.
Tilt test results
The test result is given to the test taker on the day of testing. They may indicate a disorder or illness that causes fainting. Causes of weakness or fainting may include:
- cardiovascular problems;
- low blood pressure (postural hypotension);
- vasovagal syncope associated with a sharp drop in heart rate and/or blood pressure during stress.
If fainting does not occur during the first tilt test session, subsequent sessions may be necessary.
With vasovagal syncope, a decrease in heart rate and blood pressure is most often observed. But in some people with a cardioinhibitory response, only the heart rate decreases, while in others with a vasodepressor response, only blood pressure decreases.
There are other options:
- a decrease in only diastolic or only systolic pressure, while heart rate changes slightly - this is how a disautonomous reaction is expressed;
- a pronounced increase in heart rate (by more than 30 beats) with a slight change in blood pressure.
Sometimes syncope can develop completely without hemodynamic changes, in which case, when deciding how to evaluate a tilt test, in cardiology they talk about psychogenic syncope.
Vasovagal (sinocarotid) syncope
- Type 1 (mixed), in which blood pressure drops before heart rate drops to 40 beats/min. or less, but not lower than 30 beats/min.
- Type 2A (depression of cardiac activity without asystole) in which blood pressure falls before the heart rate decreases, the pulse decreases for more than 10 seconds to a value of no more than 40 beats per minute, and asystole lasts no longer than 3 seconds.
- Type 2B (cardiac depression with asystole) - in this case, blood pressure drops simultaneously with or precedes heart rate, and asystole lasts more than 3 seconds.
- Type 3 (vasodilator) in which during fainting the heart rate decreases by no more than 10% of the maximum.
But there are exceptions:
- when during the test the heart rate does not increase or increases by no more than 10% of normal;
- excessive increase in heart rate to more than 130 beats/min. not only at the beginning of the ascent, but throughout the entire test, right up to fainting.
Increased sensitivity of the carotid sinus
- detected during massage of the carotid sinus;
- asystole lasts more than 3 s. (subtype with a decrease in cardiac activity);
- decrease in systolic blood pressure by more than 50 mm Hg. Art. (subtype with vasodilation);
- asystole lasts more than 3 s. with a simultaneous drop in systolic blood pressure by more than 50 mm Hg. Art. (mixed subtype).
Postural orthostatic tachycardia syndrome
- an increase in heart rate by more than 30 units or reaching 120 beats/min;
- absence of severe hypotension;
- symptoms of fatigue, dizziness, lightheadedness.
Have you been prescribed a tilt test? Have you passed it? Tell us about your feelings and examination results in the comments.
Tilt test (passive orthostatic test) used to study the mechanisms of impaired autonomic regulation and the development of syncope.
The tilt test is used to diagnose syncope both in practically healthy young people, as well as in older people, if it is impossible to make a diagnosis using other methods. The tilt test (passive orthostatic test) is considered today as the “gold standard” in the examination of patients with syncope of unknown etiology.
In its simplest form, the tilt test involves changing the patient's body position from horizontal to vertical. In this case, under the influence, blood is deposited in the lower part of the body. During the test, conditions are created for venous stagnation, which provokes the appearance of symptoms such as nausea, dizziness, pale skin, hypotension, bradycardia and the occurrence of vasovagal syncope. In patients with carotid sinus hypersensitivity syndrome, cardiovagal tone increases and loss of consciousness occurs.
Methodology for conducting a tilt test in a hospital setting:
- After a 12-hour break from eating, the patient is placed on a movable table with seat belts. The tilt test table must have a foot rest and provide reliable support for the patient to avoid falls and bruises in the event of loss of consciousness.
- The table with the subject is placed horizontally for a period of 15 to 45 minutes.
- Next, the head of the table is raised at an angle of 60-80°, and the patient remains in this position for 45 minutes.
- ECG and blood pressure are continuously monitored.
- When vasovagal symptoms occur, syncope is diagnosed.
- If there are no symptoms, then the drug isoproterenol is administered to provoke syncope. Isoproterenol should not be used in patients with hypertrophic cardiomyopathy.
- The sensitivity of this test depends on the protocol used and ranges from 30-80%.
- False-positive results are observed in 10-15% of cases.
Relative contraindications for the test are: severe aortic or mitral stenosis, severe ischemic heart disease.
With vasovagal syncope, heart rate and blood pressure levels decrease. In some patients, only a decrease in heart rate is recorded (cardioinhibitory positive response); in others, only a decrease in blood pressure (vasodepressive positive response). In some cases, the following may be observed: a gradual decrease in systolic and diastolic blood pressure and minor changes in heart rate (a sign of dysautonomia); a significant increase in heart rate (by more than 30 beats per minute) and slight changes in blood pressure (postural orthostatic tachycardia syndrome); development of syncope without hemodynamic disturbances (psychogenic fainting).
If syncope occurs during the test, the nature of its development is assessed. Positive results of the tilt test.