Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1992 Jun;67(6):486–490. doi: 10.1136/hrt.67.6.486

Lack of variation in venous tone potentiates vasovagal syncope.

A D Hargreaves 1, A L Muir 1
PMCID: PMC1024893  PMID: 1622700

Abstract

OBJECTIVE--To investigate the peripheral venous response to head up tilting in malignant vasovagal syndrome. PATIENTS--31 Patients with unexplained syncope or dizziness referred from the cardiology department. METHODS--Changes in calf venous volume were studied by a radionuclide technique during 45 degrees head up tilt testing. RESULTS--During tilt testing six patients became syncopal but 25 were symptom free. The syncopal group had greater increases in calf venous volume after the change in posture and perhaps more importantly considerably less variability in the venous volume during the tilted period. CONCLUSIONS--The venous response was different in the syncopal patients. The lack of response of the peripheral venous circulation to changes in the central circulation may be responsible for triggering the Bezold-Jarisch reflex and malignant vasovagal syncope.

Full text

PDF
490

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Almquist A., Goldenberg I. F., Milstein S., Chen M. Y., Chen X. C., Hansen R., Gornick C. C., Benditt D. G. Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope. N Engl J Med. 1989 Feb 9;320(6):346–351. doi: 10.1056/NEJM198902093200603. [DOI] [PubMed] [Google Scholar]
  2. Capewell S., Taverner D., Hannan W. J., Muir A. L. Acute and chronic arterial and venous effects of captopril in congestive cardiac failure. BMJ. 1989 Oct 14;299(6705):942–945. doi: 10.1136/bmj.299.6705.942. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Come P. C., Pitt B. Nitroglycerin-induced severe hypotension and bradycardia in patients with acute myocardial infarction. Circulation. 1976 Oct;54(4):624–628. doi: 10.1161/01.cir.54.4.624. [DOI] [PubMed] [Google Scholar]
  4. Epstein S. E., Stampfer M., Beiser G. D. Role of the capacitance and resistance vessels in vasovagal syncope. Circulation. 1968 Apr;37(4):524–533. doi: 10.1161/01.cir.37.4.524. [DOI] [PubMed] [Google Scholar]
  5. Fitzpatrick A. P., Theodorakis G., Vardas P., Sutton R. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol. 1991 Jan;17(1):125–130. doi: 10.1016/0735-1097(91)90714-k. [DOI] [PubMed] [Google Scholar]
  6. Fitzpatrick A., Sutton R. Tilting towards a diagnosis in recurrent unexplained syncope. Lancet. 1989 Mar 25;1(8639):658–660. doi: 10.1016/s0140-6736(89)92155-7. [DOI] [PubMed] [Google Scholar]
  7. Grassi G., Gavazzi C., Cesura A. M., Picotti G. B., Mancia G. Changes in plasma catecholamines in response to reflex modulation of sympathetic vasoconstrictor tone by cardiopulmonary receptors. Clin Sci (Lond) 1985 May;68(5):503–510. doi: 10.1042/cs0680503. [DOI] [PubMed] [Google Scholar]
  8. Lipsitz L. A., Mietus J., Moody G. B., Goldberger A. L. Spectral characteristics of heart rate variability before and during postural tilt. Relations to aging and risk of syncope. Circulation. 1990 Jun;81(6):1803–1810. doi: 10.1161/01.cir.81.6.1803. [DOI] [PubMed] [Google Scholar]
  9. Mark A. L. The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983 Jan;1(1):90–102. doi: 10.1016/s0735-1097(83)80014-x. [DOI] [PubMed] [Google Scholar]
  10. Muir A. L., Wathen C. G., Hannan W. J. Effects of felodipine on resistance and capacitance vessels in patients with essential hypertension. Drugs. 1985;29 (Suppl 2):59–65. doi: 10.2165/00003495-198500292-00012. [DOI] [PubMed] [Google Scholar]
  11. Oberg B., Thorén P. Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat. A possible cause of the vaso-vagal reaction. Acta Physiol Scand. 1972 Jun;85(2):164–173. doi: 10.1111/j.1748-1716.1972.tb05247.x. [DOI] [PubMed] [Google Scholar]
  12. PAGE E. B., HICKAM J. B., SIEKER H. O., McINTOSH H. D., PRYOR W. W. Reflex venomotor activity in normal persons and in patients with postural hypotension. Circulation. 1955 Feb;11(2):262–270. doi: 10.1161/01.cir.11.2.262. [DOI] [PubMed] [Google Scholar]
  13. Rosoff M. H., Cohen M. V. Profound bradycardia after amyl nitrite in patients with a tendency to vasovagal episodes. Br Heart J. 1986 Jan;55(1):97–100. doi: 10.1136/hrt.55.1.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Rutlen D. L., Wackers F. J., Zaret B. L. Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man. Circulation. 1981 Jul;64(1):146–152. doi: 10.1161/01.cir.64.1.146. [DOI] [PubMed] [Google Scholar]
  15. SJOSTRAND T. The regulation of the blood distribution in man. Acta Physiol Scand. 1952;26(4):312–327. doi: 10.1111/j.1748-1716.1952.tb00912.x. [DOI] [PubMed] [Google Scholar]
  16. Smith J. J., Hughes C. V., Ptacin M. J., Barney J. A., Tristani F. E., Ebert T. J. The effect of age on hemodynamic response to graded postural stress in normal men. J Gerontol. 1987 Jul;42(4):406–411. doi: 10.1093/geronj/42.4.406. [DOI] [PubMed] [Google Scholar]
  17. Strasberg B., Rechavia E., Sagie A., Kusniec J., Mager A., Sclarovsky S., Agmon J. The head-up tilt table test in patients with syncope of unknown origin. Am Heart J. 1989 Nov;118(5 Pt 1):923–927. doi: 10.1016/0002-8703(89)90225-1. [DOI] [PubMed] [Google Scholar]
  18. Wahbha M. M., Morley C. A., al-Shamma Y. M., Hainsworth R. Cardiovascular reflex responses in patients with unexplained syncope. Clin Sci (Lond) 1989 Nov;77(5):547–553. doi: 10.1042/cs0770547. [DOI] [PubMed] [Google Scholar]
  19. Wathen C. G., Hannan W. J., Adie C. J., Muir A. L. A radionuclide method for the simultaneous study of the effects of drugs on central and peripheral haemodynamics. Br J Clin Pharmacol. 1983 Jul;16(1):45–50. doi: 10.1111/j.1365-2125.1983.tb02142.x. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES