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Vasovagal syncope and long asystole on head-up tilt test in jet pilot

ISRAELI AIR FORCE AEROMEDICAL CENTER. 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. Case presentation. 23 years old otherwise healthy F-15 pilot. 2 previous unreported syncope events

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Vasovagal syncope and long asystole on head-up tilt test in jet pilot

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  1. ISRAELI AIR FORCE AEROMEDICAL CENTER 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

  2. 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.

  3. E.E.G.: Normal. • Neurological exam: Normal. • 12 leads ECG,echocardiography, treadmill and holter:normal • Head tilt test:Positive

  4. Diagnosis Vasovagal syncope- recurrent episodes Should the aviator get a waiver?

  5. Vasovagal Syncope • Common cause of recurrent syncope • Mechanisms • Malignant vasovagal syncope • Diagnosis

  6. 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.

  7. 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.

  8. Treatment for vasovagal syncope • Conservative management • Pharmacological therapy • Pacemakers

  9. Waivers-military • Incidence USAF population :12-48%. • USAF\US Navy: vasovagal syncope with a known risk factor is waivered.

  10. Waivers-civilian • F.A.A.: waiver in a case of avoidable etiology • J.A.A.: Waiver after single vasovagal episode

  11. Risk assessment • 4% a year with < 5 episodes . • Mortality :very low. • No evidence of prior episodes of syncope or presyncope during flights.

  12. 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

  13. Our Decision • Waiver for high performance platforms was not granted. • A waiver for multicrew low performance platform was granted. • Subsequently, the aviator stopped flying

  14. THANK YOU

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