Yakup ERGÜL, Aygün DİNDAR, Ümrah AYDOĞAN, Rukiye Eker Eker ÖMEROĞLU, Türkan ERTUĞRUL

Çocuk ve ergenlerde vazovagal senkop tanısında izosorbid dinitrat sprey ile uyarılmış “tilt” testinin kullanımı Orijinal Araştırma

Amaç: Vazovagal senkop nörokardiyojenik çocukluk çağında görülen senkopların en sık nedenidir Genellikle ergen kızlarda daha sıktır ve 10 yaşından önce görülmesi ise nadirdir “Tilt” testi ortostatik stres oluşturarak hastaların yakınmalarını ortaya çıkarır ve kalp ritminin yakından izlenmesi ile birlikte senkop tipini belirlemede yardımcı olur “Tilt” testi tek başına negatif olanlarda izoproterenol veya izosorbid dinitrat İSDN gibi farmakolojik maddelerle testin duyarlılığı artırılabilir Gereç ve Yöntem: Bu çalışmada yaşları 9 18 yıl arasında değişen ve tekrarlayıcı özellikte açıklanamayan senkop yakınması ile gelen 88 hasta “tilt” testi 70°’de 30 dakika süreli ile değerlendirildi Bu “tilt” testi ile senkop gelişmeyen hastalara dilaltı 400 mikrogram dozunda İSDN sprey uygulandı ve bulgular gelişene kadar ya da 15 dakika boyunca yakın izleme alındı Bulgular: Hastaların 24’ünde 27 ilaçsız ve ISDN sprey ile uyarılmış “tilt” testi ile senkop oluşmazken 24 27 hastada ilaçsız “tilt” testiyle 40 46 hastada ise İSDN uyarısıyla senkop gelişti Senkop gelişen 64 hastanın 24’ünde 37 ilaçsız “tilt” testiyle 40’ında 63 ise İSDN sprey ile uyarılmış “tilt” testiyle senkop gelişti İzosorbid dinitrat sprey uygulanan hastalarda yan etki gözlenmedi Vazovagal senkop gelişen olguların 37’si 58 miks tip altısı 9 asistolisiz kardiyoinhibitör tip yedisi 11 asistolili kardiyoinhibitör tip ve 14’ü 22 vazodepresör tipti Çıkarımlar: Bu çalışma vazovagal senkop şüphesi olan çocukların tanısında İSDN spreyle uyarılmış “tilt” testinin güvenli ve kolay olarak uygulanabileceğini ve ilaçsız “tilt” testinin tanısal değerini yükselttiğini göstermektedir Türk Ped Arş 2009; 44: 94 8 Anahtar kelimeler: İzosorbid dinitrat “tilt” testi vazovagal senkop

Anahtar Kelimeler:

İzosorbid dinitrat, “tilt” testi, vazovagal senkop

Isosorbide dinitrate spray stimulated tilt test for diagnosis of vasovagal syncope in children and adolescents Original Article

Aim: Vasovagal syncope neurocardiogenic is the most common cause of syncope in childhood It is generally more common among adolescent girls and rare before the age of 10 years Head up tilt table test provides the ability to provoke vasovagal test and helps to document the type of response by cardiac rhythm and blood pressure monitorization If basal tilt test is negative pharmacologic stimulation with isoproterenol or isosorbide dinitrate ISDN administiration may increase the sensitivity of the test Material and Method: In this study 88 patients aged 9 18 years having repeated unexplored syncope were evaluated by tilt test at 70° for 30 minutes The patients who did not develop syncope by this test were given 400 micrograms of ISDN spray sublingually and were kept under close monitoring until the findings were seen or if not for 15 minutes Results: Twentyfour patients 37 had a positive basal tilt test Forty patients 46 had syncope following ISDN administiration No side effect related to ISDN administirastion was observed The types of positive responses were mixed type in 37 patients 58 cardioinhibitory without asystole in six patients 9 cardioinhibitory with asystole in seven patients 11 and vasodepressor types in 14 patients 22 respectively Conclusions: This study concludes that pharmacological stimulation with sublingual ISDN is safe and easy to perform in children considered to have vasovagal syncope clinically and helps to increase the diagnostic value of tilt testing Turk Arch Ped 2009; 44: 94 8 Key words: Isosorbide dinitrate spray tilt test vasovagal syncope

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