Hugo Ector, Tony Reybrouck*°,
Hein Heidbüchel, Marc Gewillig*, Frans Van de Werf.
Departments of Cardiology, *Pediatric Cardiology and °Cardiovascular Rehabilitation,
University Hospital Gasthuisberg, Leuven, Belgium
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Although the neurally mediated syncopal syndromes are
the most frequent causes of fainting episodes in humans, our understanding of the
pathophysiology and appropriate management of these conditions has been slow to progress1,2. In the assessment of syncope, the head-up tilt table
test, is the appropriate diagnostic tool3. A wide
variety of medical treatments have been proposed: disopyramide, beta-blocking agents,
fludrocortisone, theophylline, clonidine, ephedrine, etilephrine, salt and fluid
supplements, serotonin reuptake inhibitors, sleeping in a head-up bed, cardiac pacing4-8. However, this multitude of strategies reflects the
unpredictable and unsatisfactory therapeutic results. In patients undergoing repeated tilt
table tests, we have experienced a prompt improvement in tilt tolerance. We hypothesized,
that the repeated and prolonged exposure of the cardiovascular system to gravitational
stress, might have a therapeutic effect in patients with orthostatic intolerance. We have
initiated a rehabilitation program of systematic tilt training in a group of patients with
recurrent syncope and orthostatic intolerance.
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