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. 1996 May;75(5):528–530. doi: 10.1136/hrt.75.5.528

Autonomic control of asystolic vasovagal syncope.

D L Jardine 1, H Ikram 1, I G Crozier 1
PMCID: PMC484357  PMID: 8665351

Abstract

A 30 year old woman with a lifelong history of severe, recurrent, vasovagal syncope became asystolic for 30 seconds after 37 minutes of 60 degrees head-up tilt. During early tilt, sympathetic activity, heart rate, left ventricular contractility, and cardiac output increased. Mean blood pressure was initially maintained. Presyncope was associated with maximal contractility and bradycardia despite sustained sympathetic activity. Subsequently, asystole occurred associated with complete withdrawal of muscle nerve sympathetic activity. In asystolic vasovagal reactions, presyncope may be triggered by increased left ventricular contractility and is associated with increased levels of parasympathetic and sympathetic activity. Asystole and peripheral vasodilatation may be caused by sudden and complete withdrawal of the increased sympathetic activity.

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Selected References

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  1. Abboud F. M., Eckberg D. L., Johannsen U. J., Mark A. L. Carotid and cardiopulmonary baroreceptor control of splanchnic and forearm vascular resistance during venous pooling in man. J Physiol. 1979 Jan;286:173–184. doi: 10.1113/jphysiol.1979.sp012612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baharav A., Mimouni M., Lehrman-Sagie T., Izraeli S., Akselrod S. Spectral analysis of heart rate in vasovagal syncope: the autonomic nervous system in vasovagal syncope. Clin Auton Res. 1993 Aug;3(4):261–269. doi: 10.1007/BF01829016. [DOI] [PubMed] [Google Scholar]
  3. Engel G. L. Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med. 1978 Sep;89(3):403–412. doi: 10.7326/0003-4819-89-3-403. [DOI] [PubMed] [Google Scholar]
  4. Fitzpatrick A. P., Banner N., Cheng A., Yacoub M., Sutton R. Vasovagal reactions may occur after orthotopic heart transplantation. J Am Coll Cardiol. 1993 Apr;21(5):1132–1137. doi: 10.1016/0735-1097(93)90235-s. [DOI] [PubMed] [Google Scholar]
  5. GRAHAM D. T., KABLER J. D., LUNSFORD L., Jr Vasovagal fainting: a diphasic response. Psychosom Med. 1961 Nov-Dec;23:493–507. doi: 10.1097/00006842-196111000-00004. [DOI] [PubMed] [Google Scholar]
  6. Goldstein D. S., Spanarkel M., Pitterman A., Toltzis R., Gratz E., Epstein S., Keiser H. R. Circulatory control mechanisms in vasodepressor syncope. Am Heart J. 1982 Nov;104(5 Pt 1):1071–1075. doi: 10.1016/0002-8703(82)90442-2. [DOI] [PubMed] [Google Scholar]
  7. Johnson J. M., Rowell L. B., Niederberger M., Eisman M. M. Human splanchnic and forearm vasoconstrictor responses to reductions of right atrial and aortic pressures. Circ Res. 1974 Apr;34(4):515–524. doi: 10.1161/01.res.34.4.515. [DOI] [PubMed] [Google Scholar]
  8. Kosinski D., Grubb B. P., Temesy-Armos P. Pathophysiological aspects of neurocardiogenic syncope: current concepts and new perspectives. Pacing Clin Electrophysiol. 1995 Apr;18(4 Pt 1):716–724. doi: 10.1111/j.1540-8159.1995.tb04666.x. [DOI] [PubMed] [Google Scholar]
  9. Lepicovska V., Novak P., Nadeau R. Time-frequency dynamics in neurally mediated syncope. Clin Auton Res. 1992 Oct;2(5):317–326. doi: 10.1007/BF01824302. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. Maloney J. D., Jaeger F. J., Fouad-Tarazi F. M., Morris H. H. Malignant vasovagal syncope: prolonged asystole provoked by head-up tilt. Case report and review of diagnosis, pathophysiology, and therapy. Cleve Clin J Med. 1988 Nov-Dec;55(6):542–548. doi: 10.3949/ccjm.55.6.542. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Rea R. F., Thames M. D. Neural control mechanisms and vasovagal syncope. J Cardiovasc Electrophysiol. 1993 Oct;4(5):587–595. doi: 10.1111/j.1540-8167.1993.tb01246.x. [DOI] [PubMed] [Google Scholar]
  14. Sander-Jensen K., Secher N. H., Astrup A., Christensen N. J., Giese J., Schwartz T. W., Warberg J., Bie P. Hypotension induced by passive head-up tilt: endocrine and circulatory mechanisms. Am J Physiol. 1986 Oct;251(4 Pt 2):R742–R748. doi: 10.1152/ajpregu.1986.251.4.R742. [DOI] [PubMed] [Google Scholar]
  15. Sanders J. S., Ferguson D. W. Profound sympathoinhibition complicating hypovolemia in humans. Ann Intern Med. 1989 Sep 1;111(5):439–441. doi: 10.7326/0003-4819-111-5-439. [DOI] [PubMed] [Google Scholar]
  16. Sanders J. S., Mark A. L., Ferguson D. W. Evidence for cholinergically mediated vasodilation at the beginning of isometric exercise in humans. Circulation. 1989 Apr;79(4):815–824. doi: 10.1161/01.cir.79.4.815. [DOI] [PubMed] [Google Scholar]
  17. Shalev Y., Gal R., Tchou P. J., Anderson A. J., Avitall B., Akhtar M., Jazayeri M. R. Echocardiographic demonstration of decreased left ventricular dimensions and vigorous myocardial contraction during syncope induced by head-up tilt. J Am Coll Cardiol. 1991 Sep;18(3):746–751. doi: 10.1016/0735-1097(91)90798-e. [DOI] [PubMed] [Google Scholar]
  18. Sundlöf G., Wallin B. G. Human muscle nerve sympathetic activity at rest. Relationship to blood pressure and age. J Physiol. 1978 Jan;274:621–637. doi: 10.1113/jphysiol.1978.sp012170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. 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]
  20. Wallin B. G., Sundlöf G. Sympathetic outflow to muscles during vasovagal syncope. J Auton Nerv Syst. 1982 Nov;6(3):287–291. doi: 10.1016/0165-1838(82)90001-7. [DOI] [PubMed] [Google Scholar]
  21. Yatomi A., Iguchi A., Uemura K., Sakamoto N., Iwase S., Mano T. A rare case of recurrent vasodepressive attacks of 2-hours duration: analysis of the mechanism by muscle sympathetic nerve activity recording. Clin Cardiol. 1989 Mar;12(3):164–168. doi: 10.1002/clc.4960120311. [DOI] [PubMed] [Google Scholar]
  22. al-Timman J. K., Hainsworth R. Reflex vascular responses to changes in left ventricular pressures, heart rate and inotropic state in dogs. Exp Physiol. 1992 May;77(3):455–469. doi: 10.1113/expphysiol.1992.sp003606. [DOI] [PubMed] [Google Scholar]
  23. 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]

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