Uloga "tilt-table" testa u dijagnostici sinkopa

master's thesis

• Title (english): The role of tilt table test in diagnostics of syncope
• Author: Arijana Crevar
• Mentor: Martina Lovrić Benčić (mentor)
• Committee member: Davor Puljević (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Sinkopa je stanje koje se dogodi velikom dijelu populacije barem jednom u životu. Dolazi do prolaznog gubitka svijesti zbog prolazne globalne hipoperfuzije mozga. U ovom radu na Klinici za bolesti srca i krvnih žila KBC Zagreb obrađeni su rezultati “tilt-table” testa pacijenata kroz tri godine. Najčešće je sinkopa bezopasna, ali isto tako može biti znak neke opasnije podležeće bolesti kao što su strukturalne bolesti srca ili aritmije, a osim toga zbog sinkope može doći do ozljeda bolesnika ili smrti. Upravo je zbog toga važno obraditi svakog pacijenta sa sinkopom kako bi se otkrio uzrok odnosno mehanizam sinkope i ako postoji neko životno ugrožavajuće stanje pacijent liječio. Europsko kardiološko društvo klasificira sinkopu prema patofiziološkom mehanizmu u refleksnu odnosno neurološki posredovanu sinkopu, sinkopu zbog ortostatske hipotenzije i kardijalnu sinkopu. Uzroci sinkope se mogu podijeliti u šest velikih kategorija, a to su neurološki poremećaji, metabolički poremećaji, strukturalne bolesti srca, srčane aritmije, psihijatrijski poremećaji i disfunkcija autonomnog živčanog sustava. Primarna obrada pacijenata sa sinkopom obuhvaća anamnezu, fizikalni pregled, mjerenje krvnog tlaka, pulsa, saturacije kisikom i standardni 12-kanalni EKG. Daljnja obrada pacijenta sa sinkopom ovisi o etiologiji na koju upućuje primarna obrada, a tu se ubraja i “tilt-table” test. “Tilt-table” test je jednostavna, neinvazivna pretraga koja omogućava dijagnostiku refleksne sinkope, ali je isto tako indicirana i kada pretrage u primarnoj obradi nisu otkrile ništa o uzroku sinkope. Informativan je i omogućava reproduciranje simptoma koji prethode sinkopi i same sinkope, a s obzirom da se tijekom cijelog testa bilježe krvni tlak i srčani ritam te pacijentovi simptomi i znakovi može pridonijeti i otkrivanju uzroka sinkope i biti pomoć pri odluci o daljnjem liječenju.

Abstract (english)

Syncope is a state that affects a large proportion of population at least once in a lifetime. It is defined as a transient loss of consciousness due to transient global cerebral hypoperfusion. The results of tilt table test from patients in the Cardiovascular Disease Department of the UHC Zagreb were analysed in this diploma paper for period of three years. In most cases syncope is benign but can also be a sign of an underlying condition that is more dangerous, like structural heart disease or arrhythmias. It can also result with injuries or death. Precisely because of that it is important to do a whole workup on a patient with syncope to discover the cause and the mechanism of syncope and to treat the patient if the cause is a life threatening state. Due to pathological mechanism the European Society of Cardiology classifies syncope into three categories: reflex or neurally mediated syncope, syncope due to orthostatic hypotension and cardiac syncope. The cause of syncope can be divided into six large categories: neurological disorders, metabolic disorders, structural heart disease, cardiac arrhythmias, dysfunction of autonomic nervous system and psychiatric disorders. Primary workup of a patient with syncope consists of medical history, examination, blood pressure, pulse, oxygen saturation and a standard 12-lead ECG. Further workup of patients with syncope depends on the etiology the primary workup points to. Tilt-table is further workup test. Tilt-table test is a simple, noninvasive test that enables the diagnostics of reflex syncope, but is also indicated when primary workup tests did not discover the cause. It is informative and enables the reproduction of symptoms and syncope itself. Considering the fact that blood pressure, heart rhythm, signs and symptoms are constantly monitored during the test it can also contribute to the discovery of the syncope cause and help decide about the treatment.

• Keywords: sinkopa; “tilt-table” test; dijagnostika
• Keywords (english): syncope; tilt-table test; diagnostics
• Language: croatian
• URN:NBN: urn:nbn:hr:105:508487
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-11-08 12:36:44