I have noticed an unusually large number of patients (>20) with neurocardiogenic syncope (all of the patients had positive tilt-table tests). Is this a recent trend? If so, what is the cause?
—CHERYL L. LEWIS, FNP, Morehead City, N.C.

A subject number >20 is really not enough to make a valid comparison. To establish a trend, it would be better to have a clear proportion, such as 20 out of 25 patients or 20 out of 2,000 patients as well as an identified age group.

More information is necessary to determine whether a patient’s neurocardiogenic syncope (vasovagal syncope) is cardiac or neurologic in origin. Prior to the tilt test, a thorough history, physical exam, and
12-lead ECG should be obtained.
—Debra Kleinschmidt, PhD, PA (119-11)