There are a lot of reasons of recurrent syncope.

Actually, the diagnostic role of Tilt table test is now not clear.

In my opinion, Implantable event recorder should be preferred test in the Tilt negative recurrent syncope. 

Dear Prof Tolga,

My sentiment exactly.

But does it matter if the patient is a Complex Regional Pain Syndrome (CRPS) Type 1 candidate?

Can the implantable event recorder benefit him?

Best regards - Mariam

Dear Dr Bahram,

Thank you for your kind input.

Isn't vasovagal, orthostatic and even conversion could be sufficiently tested and diagnosed on the tilt table for such recurrent syncope almost immediately?

If the loop recorder can ONLY diagnose the vasovagal type and the heart rate is in continuum for orthostatic and conversion accordingly, would it not be a waste of money and time just to perform this tilt table test unless the recorder is the gold standard for such diagnosis which has yet to earn its own place?

Consider, for example - would CVM issue like enlarged heart makes it difficult for the patient to receive oxygen timely owing to its size that would be the result of the recurrent syncope? 

What diagnostic test would be in its own place for this case?

Otherwise what test is needed for 45 mins intermittent BP of 140/90 and drop to 100/50  and rising again to 140/90 with consistent heart rate of 110 without GTN and 15 mins upscaling 150 with BP 140/90 during this GTN tilt table test?

What could this "in-place" diagnostic test tells then apart from being a negative GTN tilt table test?

Best regards - Mariam

Dear Dr Bahram,

FYI, the patient did not faint during the tilt table test even though his BP dropped at 100/50 when his HR was consistent at 110 without GTN induction.

Best regards - Mariam