Clinical Case Database / Category: Case Based Discussion

The head-up tilt-table test: a diagnostic tool for vasovagal syncope

Publication details

Gordon W Duncan MRCP, Maw Pin Tan MRCP, Steve W Parry FRCP
Foundation Years Journal, volume 2, issue 6, p.289 (123Doc Education, London, July 2008)


A 32-year-old sales manager was referred by her consultant neurologist to a specialist falls and syncope unit for further evaluation of transient loss of consciousness. She had experienced episodes of blackouts, occasionally with twitching movements, and was incontinent of urine on one occasion. The neurologist had performed an MRI of her brain and an EEG, neither of which demonstrated any abnormalities. She had been unable to work as two of her blackouts occurred during boardroom presentations and her job also involved driving long distances.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


Gordon W Duncan MRCP

Specialty Registrar
Falls and Syncope Service
Royal Victoria Infirmary
Newcastle upon Tyne

Maw Pin Tan MRCP

Research Fellow
Institute for Ageing and Health
Newcastle University
Honorary Specialist Registrar, Falls and Syncope Service,
Royal Victoria Infirmary, Newcastle upon Tyne

Steve W Parry FRCP (Corresponding author)

Senior Lecturer
Institute for Ageing and Health
Newcastle University
Honorary Consultant
Falls and Syncope Service
Royal Victoria Infirmary
Queen Victoria Road
Newcastle upon Tyne


1. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al. Guidelines on management (diagnosis and treatment) of syncope. Europace 2004 6(6):467–537.
2. Ganzeboom KS, Mairuhu G, R eitsma JB, Linzer M, W ieling W, van Dijk N. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. Journal of Cardiovascular Electrophysiology 2006 17(11):1172–1176.
3. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, et al. Incidence and prognosis of syncope. New England Journal of Medicine 2002 347(12):878–885.
4. Brignole M, Menozzi C, Bartoletti A, Giada F, Lagi A, Ungar A, et al. A new management of syncope: Prospective systematic guideline-based evaluation of patients referred urgently to general hospitals. European Heart Journal 2006 27(1):76–82.
5. Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick AP. Misdiagnosis of epilepsy: Many seizure-like attacks have a cardiovascular cause. Journal of the American College of Cardiology 2000 36(1):181–184.
6. Alboni P, Brignole M, Menozzi C, Raviele A, Del R osso A, Dinelli M, et al. Diagnostic value of history in patients with syncope with or without heart disease. Journal of the American College of Cardiology 2001 37(7):1921–1928.
7. Boon NR and Grub NA. Dizziness spells and syncope – Investigation and Management. The Foundation Years 2008 4(3):117–123.
8. Kenny RA, Ingram A, Bayliss J, Sutton R. Head-up tilt: A useful test for investigating unexplained syncope. Lancet 1986 1(8494):1352–1355.
9. Parry SW, Reeve P, Lawson J, Shaw FE, Davison J, Norton M, et al. The Newcastle Protocols 2008: An update on head-up tilt-table testing and the management of vasovagal syncope and related disorders. Heart August 2008.
10. For medical practitioners. At a glance guide to the current medical standards of fitness to drive. Drivers Medical Group, DVLA, Swansea. February 2008:7–8.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.