Presentation on theme: "Vasovagal syncope and long asystole on head-up tilt test in jet pilot Dan Carter M.D., Bella Azaria M.D., Alon Grossman M.D., Liav Goldstein M.D.,M.ha."— Presentation transcript:
Vasovagal syncope and long asystole on head-up tilt test in jet pilot Dan Carter M.D., Bella Azaria M.D., Alon Grossman M.D., Liav Goldstein M.D.,M.ha ISRAELI AIR FORCE AEROMEDICAL CENTER
Case presentation 23 years old otherwise healthy F-15 pilot. 2 previous unreported syncope events An episode of syncope that lasted for a minute on routine E.N.T. exam Fast and full recovery.
E.E.G.: Normal. Neurological exam: Normal. 12 leads ECG,echocardiography, treadmill and holter:normal Head tilt test:Positive
Diagnosis Vasovagal syncope- recurrent episodes Should the aviator get a waiver?
Vasovagal Syncope Common cause of recurrent syncope Mechanisms Malignant vasovagal syncope Diagnosis
Indications for head tilt table Recurrent episodes of syncope. A single episode of syncope that ended in a serious injury. ( such as MVA). A single episode of syncope in high risk patient. Syncope induced by known etiology, in which the choice of treatment can be influenced by the existence of vasovagal syncope.
Asystole during head-up tilt test Asystole during head-up tilt test does not imply a malignant outcome, and syncope recurrence is low. Baron-esquivias et. Al:Long term outcome of patients with asystole induced by head-up tilt test.Eur.Heart J,2002. Asystole during head-up tilt testing does not predict either a more malignant outcome… Dhala et al:Relevance of asystole during head-up tilt testing. Am J Cardiol, 1995.
Treatment for vasovagal syncope Conservative management Pharmacological therapy Pacemakers
Waivers-military Incidence USAF population :12-48%. USAF\US Navy : USAF\US Navy : vasovagal syncope with a known risk factor is waivered.
Waivers-civilian F.A.A.:F.A.A.: waiver in a case of avoidable etiology J.A.AJ.A.A.: Waiver after single vasovagal episode
Risk assessment 4% a year with < 5 episodes. Mortality :very low. No evidence of prior episodes of syncope or presyncope during flights.
Cardiology consults Waiver should be granted for two seated high performance platform. Waiver should be granted for two seated high performance platform, after gradual exposure to stimulants Waiver should be granted to cargo multicrew platform. The aviator should be granted unlimited waiver after exposure to stimulants like centrifuge exercise
Our Decision Waiver for high performance platforms was not granted. A waiver for multicrew low performance platform was granted. Subsequently, the aviator stopped flying