Neurocardiogenic sycope and related disorders of orthostatic intolerance

Cardiology Department of Medicine, the Medical University of Ohio, Toledo, Ohio 43614, USA.
Circulation (Impact Factor: 14.95). 07/2005; 111(22):2997-3006. DOI: 10.1161/CIRCULATIONAHA.104.482018
Source: PubMed

ABSTRACT The ANS is both complex and diverse and is involved in essentially every organ system and in the majority of disease processes. Disruptions in this system can be incredibly diverse in presentation, yet often culminate in a failure to maintain normotension, with resultant near syncope and syncope. A working knowledge of these disorders is required for both their recognition and their management. Further investigations will aid in our understanding of this wide range of disorders and at the same time identify better diagnostic and therapeutic modalities.

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Available from: Blair Grubb, Aug 16, 2015
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    • "Various measurements throughout the day, including before and after meals, after medication, and before bed, or ambulatory blood pressure monitoring and measurements on different days, may be needed for patients with symptoms but normal blood pressure, or for differentiating between OH and postprandial hypotension (Feldstein & Weder, 2012; Gupta & Lipsitz, 2007). For those with unexplained recurrent syncope or suspected of neurocardiogenic syncope, OH can be diagnosed when a head-up tilt test is positive to an angle between 60 • and 80 • while standing for 3 min (Figueroa et al., 2010; Grubb, 2005; Moya et al., 2009; Vetta et al., 2009). In addition, measuring heart rate before and after standing is helpful; an increase in heart rate of less than 10 beats/min indicates baroreflex impairment, while an increase of more than 20 beats/min implies volume deficiency or orthostatic intolerance (Gupta & Lipsitz, 2007). "
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    ABSTRACT: To enhance awareness of orthostatic hypotension (OH) in older populations, and guide primary care nurse practitioners (NPs) in the assessment and management of patients with OH. Electronic data collection was conducted on studies and reviews that were published between 2005 and 2012 in English, and contained information related to the purpose of this article from following databases: PubMed, Scopus, and MEDLINE. OH is a syndrome that is accompanied by unfavorable symptoms such as dizziness, and headaches and can impede the individual's daily activities and quality of life. The prevalence of OH is higher in older people because of comorbidities, polypharmacy, and physiological changes that occur with aging. OH is diagnosed with serial blood pressure measurements and the primary goal of management is to relieve unfavorable symptoms and enhance patient safety. Pharmacological management is considered when nonpharmacological interventions fail. OH is not a problem to be taken lightly as it is highly related to the risk of falling and cardiovascular problems, as well as increasing morbidity and mortality rates. NPs can contribute to improving the quality of life for older adults and reducing adverse consequences by understanding OH and adequately managing it.
    09/2013; 25(9):451-8. DOI:10.1002/2327-6924.12026
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    • "Guidelines for pacemaker implantation in patients with IA or symptomatic IB are missing and randomized, controlled trials to assess the benefit of pacemaker therapy will be not feasible due to rareness of IA or IB. Another common cause for symptomatic bradyarrhythmias is vasovagal syncope , which has a benign prognosis except for the related injuries (Grubb, 2005). The effectiveness of cardiac pacing has been investigated in five multicenter, randomized, controlled trials with contradictory results (Vardas et al., 2007). "
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    ABSTRACT: Ictal asystole (IA) and ictal bradycardia (IB) are rare autonomic symptoms during epileptic seizures and may be potentially life-threatening. Guidelines for the care of these patients are missing. The aim of this multicenter study was to evaluate the management and long-term outcome in patients with IA and IB. All patients with IA and IB were included from four epilepsy centers (Bielefeld, Kork, Marburg, and Zürich) from 2002 until 2009. Using a standardized assessment form, clinical data, treatment decisions, and outcomes were extracted from patient charts and simultaneous electroencephalography/electrocardiography (EEG/ECG) recordings. Seizures with IA or IB were identified in 16 patients. In all patients an associated temporal seizure pattern was recorded and in 15 patients, sudden falls, fainting, or trauma was previously reported or recorded during the monitoring. In three patients (18.8%) diagnosis of focal epilepsy was newly established and anticonvulsive treatment was initiated. Two patients with refractory epilepsy underwent epilepsy surgery. In seven patients (43.8%) a cardiac pacemaker was implanted. In 14 of 16 treated patients, seizure freedom (n = 5) or absence of sudden falls, fainting, or trauma (n = 9) could be achieved. Two patients denied epilepsy surgery as well as a pacemaker and continue to have frequent falls and trauma. Our study demonstrates that epilepsy surgery and antiepileptic drugs may lead to sustained freedom of seizures as well as ictal syncope. In drug-resistant patients not suitable for epilepsy surgery, implantation of a cardiac pacemaker may prevent sudden falls as well as trauma. Based on our results and previously reported cases we propose a treatment algorithm.
    Epilepsia 02/2011; 52(6):1160-7. DOI:10.1111/j.1528-1167.2010.02961.x · 4.58 Impact Factor
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    ABSTRACT: Objective: To evaluate the serious response during tilt-table test (TTT) and its prophylactic management. Method: Seventy-six elderly patients were tested at a tilt angle of 70 degrees for a maximum of 45 min and then subjected to isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and patients were kept at normal saline condition through a peripheral intravenous duct. results: Fifty-one of 76 patients were defined as positive including 23 having serious response; 6 of the 23 patients had arteriosclerosis involving internal carotid arteries and 7 cases had bradycardia, two of which were associated with II0-I A-V block and the others with chronic atrial fibrillation. The serious response consisted of cardiac arrest for more than 5 s (6 cases), or serious bradycardia for more than 1 min (7 cases) or serious hypotension for more than 1 min (10 cases). Those with serious response were managed by returning to supine position, thus driving up legs and intravenous atropine, CPR (2 cases with cardiac arrest) and needing oxygen supplementation (11 cases). Only 2 hypotension patients recovered gradually by 10 min after emergency management, while others recovered rapidly with no complications. Conclusion: Although non-invasive. TTT may result in serious response, especially in elderly. Therefore proper patient selection, control of isoproterenol infusion and close observation of vital signs are decisive for a safe consequence.
    Journal of Zhejiang University SCIENCE B 6(4). DOI:10.1007/BF02842469 · 1.29 Impact Factor
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