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Dear Dr. Roach: Are energy drinks safe to drink? Do they cause heart trouble?

L.B.P.

Dear L.B.P.: Energy drinks have far more sugar than I think is optimal, and enough caffeine that having more than one or two can cause significant side effects in many people. However, except under extremely high use, they are not likely to cause heart trouble unless a person has existing, significant heart disease.

Dear Dr. Roach: What is a tilt table test for?

J.C.

Dear J.C.: The tilt table test is most commonly ordered to find the cause of syncope, a sudden loss of consciousness. Most syncope cases are caused by a simple faint (called vasovagal syncope), and can be diagnosed as such by an experienced clinician after a careful history and physical exam.

In people with a history of syncope and with risk factors for coronary artery disease — blockages in the blood vessels of the heart that can lead to heart attack — it is important to evaluate for heart blockages with a stress test or angiogram.

If coronary disease is ruled out, and if syncope is recurrent, a tilt table test may be ordered. It’s sometimes used to distinguish between convulsive syncope (fainting linked to a muscle spasm) and epilepsy.

As its name implies, the tilt table is capable of moving a patient rapidly between lying down and upright while monitoring symptoms, the EKG and blood pressure. Sometimes medication is used to improve the sensitivity of the test; however, the test is neither 100 percent sensitive nor specific.

As a general internist, I seldom order this test and refer unexplained cases of recurrent syncope to a cardiologist.

Email questions to ToYourGoodHealth@med.cornell.edu.

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