MEDBULLETIN June 2026
Quiz
1. What does the ECG trace of the tilt table test show?
2. What is the diagnosis?
3. How should this patient be managed?
Answer:
Question 1: Answer: The tilt table test shows a 16.8 second asystolic pause after 60º head-up tilt and sublingual GTN challenge (see figure below).
Question 2: Answer: The diagnosis is Reflex Asystolic Syncope. The condition is most common in children and young adults and often triggered by a specific stimulus which provokes a strong vagal response. Patients experience sudden loss of consciousness, brief stiffening and look very pale. There may be limb jerking and occasionally urinary incontinence.
Question 3: Answer: The condition is usually managed conservatively with the avoidance of the specific triggers if they can be identified. Patients can also be advised to use physical counter-pressure manoeuvres (such as squatting or leg crossing) if they feel prodromal symptoms. Pacemaker insertion is rarely required unless the symptoms become more frequent and disabling.
