Abstract
Five cases of exercise induced pure vasodepressor syncope in patients without significant structural heart disease are reported. Hypotension and symptoms of syncope or pre-syncope were induced by treadmill exercise testing and in each case limited exercise performance. Evidence of inappropriate peripheral vasodilation, probably as a consequence of ventricular mechanoreceptor stimulation, was shown in all five patients. Head up tilt testing resulted in hypotension in four patients and isoprenaline infusion in the supine position resulted in hypotension in the fifth. These patients had a new condition of exercise induced neurally mediated (vasodepressor) syncope without appreciable structural cardiac abnormalities.
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Selected References
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- Abboud F. M. Ventricular syncope: is the heart a sensory organ? N Engl J Med. 1989 Feb 9;320(6):390–392. doi: 10.1056/NEJM198902093200609. [DOI] [PubMed] [Google Scholar]
- 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]
- Counihan P. J., Frenneaux M. P., Webb D. J., McKenna W. J. Abnormal vascular responses to supine exercise in hypertrophic cardiomyopathy. Circulation. 1991 Aug;84(2):686–696. doi: 10.1161/01.cir.84.2.686. [DOI] [PubMed] [Google Scholar]
- Dubach P., Froelicher V. F., Klein J., Oakes D., Grover-McKay M., Friis R. Exercise-induced hypotension in a male population. Criteria, causes, and prognosis. Circulation. 1988 Dec;78(6):1380–1387. doi: 10.1161/01.cir.78.6.1380. [DOI] [PubMed] [Google Scholar]
- Ferguson D. W., Thames M. D., Mark A. L. Effects of propranolol on reflex vascular responses to orthostatic stress in humans. Role of ventricular baroreceptors. Circulation. 1983 Apr;67(4):802–807. doi: 10.1161/01.cir.67.4.802. [DOI] [PubMed] [Google Scholar]
- 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]
- 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]
- Fleg J. L., Asante A. V. Asystole following treadmill exercise in a man without organic heart disease. Arch Intern Med. 1983 Sep;143(9):1821–1822. [PubMed] [Google Scholar]
- Fleg J. L., Lakatta E. G. Prevalence and significance of postexercise hypotension in apparently healthy subjects. Am J Cardiol. 1986 Jun 1;57(15):1380–1384. doi: 10.1016/0002-9149(86)90222-5. [DOI] [PubMed] [Google Scholar]
- Frenneaux M. P., Counihan P. J., Caforio A. L., Chikamori T., McKenna W. J. Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy. Circulation. 1990 Dec;82(6):1995–2002. doi: 10.1161/01.cir.82.6.1995. [DOI] [PubMed] [Google Scholar]
- Huycke E. C., Card H. G., Sobol S. M., Nguyen N. X., Sung R. J. Postexertional cardiac asystole in a young man without organic heart disease. Ann Intern Med. 1987 Jun;106(6):844–845. doi: 10.7326/0003-4819-106-6-844. [DOI] [PubMed] [Google Scholar]
- Iskandrian A. S., Kegel J. G., Lemlek J., Heo J., Cave V., Iskandrian B. Mechanism of exercise-induced hypotension in coronary artery disease. Am J Cardiol. 1992 Jun 15;69(19):1517–1520. doi: 10.1016/0002-9149(92)90695-u. [DOI] [PubMed] [Google Scholar]
- Mark A. L., Kioschos J. M., Abboud F. M., Heistad D. D., Schmid P. G. Abnormal vascular responses to exercise in patients with aortic stenosis. J Clin Invest. 1973 May;52(5):1138–1146. doi: 10.1172/JCI107280. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- McKenna W., Deanfield J., Faruqui A., England D., Oakley C., Goodwin J. Prognosis in hypertrophic cardiomyopathy: role of age and clinical, electrocardiographic and hemodynamic features. Am J Cardiol. 1981 Mar;47(3):532–538. doi: 10.1016/0002-9149(81)90535-x. [DOI] [PubMed] [Google Scholar]
- Milstein S., Buetikofer J., Dunnigan A., Benditt D. G., Gornick C., Reyes W. J. Usefulness of disopyramide for prevention of upright tilt-induced hypotension-bradycardia. Am J Cardiol. 1990 Jun 1;65(20):1339–1344. doi: 10.1016/0002-9149(90)91324-y. [DOI] [PubMed] [Google Scholar]
- Milstein S., Buetikofer J., Lesser J., Goldenberg I. F., Benditt D. G., Gornick C., Reyes W. J. Cardiac asystole: a manifestation of neurally mediated hypotension-bradycardia. J Am Coll Cardiol. 1989 Dec;14(7):1626–1632. doi: 10.1016/0735-1097(89)90006-5. [DOI] [PubMed] [Google Scholar]
- Sra J. S., Murthy V. S., Jazayeri M. R., Shen Y. H., Troup P. J., Avitall B., Akhtar M. Use of intravenous esmolol to predict efficacy of oral beta-adrenergic blocker therapy in patients with neurocardiogenic syncope. J Am Coll Cardiol. 1992 Feb;19(2):402–408. doi: 10.1016/0735-1097(92)90498-c. [DOI] [PubMed] [Google Scholar]
- Thorén P. Role of cardiac vagal C-fibers in cardiovascular control. Rev Physiol Biochem Pharmacol. 1979;86:1–94. doi: 10.1007/BFb0031531. [DOI] [PubMed] [Google Scholar]
- Vlay S. C. Isoproterenol-induced bradyarrhythmias. Am Heart J. 1991 Oct;122(4 Pt 1):1169–1169. doi: 10.1016/0002-8703(91)90492-z. [DOI] [PubMed] [Google Scholar]
- van Lieshout J. J., Wieling W., Karemaker J. M., Eckberg D. L. The vasovagal response. Clin Sci (Lond) 1991 Nov;81(5):575–586. doi: 10.1042/cs0810575. [DOI] [PubMed] [Google Scholar]