019Tilt Table Test Outcome in the Diagnosis and Prevalence of Syncope in Patients with Vitamin D and Vitamin B12 Deficiency

Abstract

Background: Syncope is a clinical syndrome in which transient loss of consciousness is caused by abrupt drop of systemic blood pressure for a brief duration (8 to 10 seconds) and is spontaneously self-limited. Tilt testing is recommended where a cardiac cause of syncope has been out-ruled. Reproduction of symptoms here is diagnostic. Vitamin B12 and vitamin D deficiencies are implicated in causing syncope due to autonomic dysfunction and hence an important cause to rule out when assessing a patient with orthostatic hypotension and syncopal symptoms. Methods: This is a retrospective analysis of haemodynamic changes in response to tilt table testing that were recorded by a non-invasive volume clamp technique (finometer). The following diagnoses were made: Orthostatic Hypotension (OH), Carotid Sinus Syndrome (CSS), Neuro-cardiogenic Syncope (NCS) and Postural Orthostatic Tachycardia Syndrome (POTS). Blood levels of vitamin D and vitamin B12 were checked. Results: 181 patients underwent investigation from 1st October 2015 to 30th September 2016. Mean age was 72 years. The male to female ratio was 1:1.9. 100 patients out of 181 had positive tilt table test. 46% (n = 46) met the criteria of OH. 40% (n = 40) patients were diagnosed CSS, 77% (n = 31) of these being vasodepressor and 23%(n = 9) being cardio-inhibitory. 13% (n = 13) got the diagnosis of POTS. 1 patient had NCS. Out of these 100 patients 71 had vitamin B12 or vitamin D deficiency. Hence only 29 patients had normal vitamin levels. 23%(n = 23) of patients with syncope were vitamin B12 deficient. However 56%(n = 56) of patients with syncope had vitamin D deficiency. 9 patients had deficiency of both vitamin D and vitamin B12. Conclusions: 1-The tilt table test is a useful tool in the diagnosis of syncope. 2-Vitamin D and vitamin B12 deficiencies have significant association with syncope and should be ruled out in all patients with syncope as a potential cause.