Steep fall in cardiac output is main determinant of hypotension during drug-free and nitroglycerine-induced orthostatic vasovagal syncope

Heart Rhythm

Volumn 5, Issue 12, 2008, Pages 1695-1701

  Verheyden, Bart ^a   Liu, Jiexin ^a   van Dijk, Nynke ^b   Westerhof, Berend E ^b   Reybrouck, Tony ^c   Aubert, André E ^a   Wieling, Wouter ^b  

^a UNIVERSITY OF LEUVEN   (Belgium)

^b ACADEMIC MEDICAL CENTER   (Netherlands)

^c UNIVERSITY HOSPITALS LEUVEN   (Belgium)

Author keywords

Cardiac output; Nitroglycerine; Systemic vascular resistance; Tilt test; Vasovagal syncope

Indexed keywords

GLYCERYL TRINITRATE;

ADOLESCENT; ADULT; AGED; ARTERIAL PRESSURE; ARTICLE; CONTROLLED STUDY; FEMALE; FINGER ARTERIAL PRESSURE; HEART LEFT VENTRICLE; HEART OUTPUT; HEART RATE; HEART STROKE VOLUME; HUMAN; HYPOTENSION; MAJOR CLINICAL STUDY; MALE; PRESYNCOPE; PRIORITY JOURNAL; RETROSPECTIVE STUDY; SCHOOL CHILD; SYNCOPE; TILT TABLE TEST; VASCULAR RESISTANCE;

ADULT; BLOOD PRESSURE; BODY MASS INDEX; ELECTROCARDIOGRAPHY; FEMALE; FOLLOW-UP STUDIES; HEART VENTRICLES; HUMANS; HYPOTENSION, ORTHOSTATIC; MALE; NITROGLYCERIN; RETROSPECTIVE STUDIES; STROKE VOLUME; SYNCOPE, VASOVAGAL; TILT-TABLE TEST; VASCULAR RESISTANCE; VASODILATOR AGENTS; VENTRICULAR FUNCTION, LEFT;

EID: 57249112255     PISSN: 15475271     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.hrthm.2008.09.003     Document Type: Article

References (36)

1. Brignole M., Alboni P., Benditt D.G., et al. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Europace 6 (2004) 467-537
2. Lewis T. Vasovagal syncope and the carotid sinus mechanism. BMJ 12 (1932) 873-874
3. Barcroft H., Edholm O.G., McMichael J., et al. Posthaemorrhagic fainting study by cardiac output and forearm flow. Lancet 1 (1944) 489-491
4. Barcroft H., and Edholm O.G. On the vasodilatation in human skeletal muscle during posthaemorrhagic fainting. J Physiol 104 (1945) 161-175
5. Weisler A.M., Warren J.V., Estes E.H., et al. Vasodepressor syncope; factors influencing cardiac output. Circulation 15 (1957) 875-882
6. Epstein S.E., Stampfer M., and Beiser G.D. Role of the capacitance and resistance vessels in vasovagal syncope. Circulation 37 (1968) 524-533
7. Dietz N.M., Joyner M.J., and Shepherd J.T. Vasovagal syncope and skeletal muscle vasodilatation: the continuing conundrum. Pacing Clin Electrophysiol 20 (1997) 775-780
8. Kenny R.A., Ingram A., Bayliss J., et al. Head-up tilt: a useful test for investigating unexplained syncope. Lancet 1 (1986) 1352-1355
9. Gisolf J., Westerhof B.E., van Dijk N., et al. Sublingual nitroglycerin used in routine tilt testing provokes a cardiac output-mediated vasovagal response. J Am Coll Cardiol 44 (2004) 588-593
10. Verheyden B., Gisolf J., Beckers F., et al. Impact of age on the vasovagal response provoked by sublingual nitroglycerine in routine tilt testing. Clin Sci (Lond) 113 (2007) 329-337
11. Evans J.M., Leonelli F.M., Ziegler M.G., et al. Epinephrine, vasodilation and haemoconcentration in syncopal, healthy men and women. Auton Neurosci 93 (2001) 79-90
12. Novak V., Honos G., and Schondorf R. Is the heart "empty" at syncope?. J Auton Nerv Syst 60 (1996) 83-92
13. Fitzpatrick A.P., Theodorakis G., Vardas P., et al. Methodology of head-up tilt testing in patients with unexplained syncope. J Am Coll Cardiol 17 (1991) 125-130
14. Verheyden B., Ector H., Aubert A.E., et al. Tilt training increases the vasoconstrictor reserve in patients with neurally mediated syncope evoked by head-up tilt testing. Eur Heart J 29 (2008) 1523-1530
15. Bartoletti A., Alboni P., Ammirati F., et al. "The Italian Protocol": a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope. Europace 2 (2000) 339-342
16. Wesseling K.H., Jansen J.R., Settels J.J., et al. Computation of aortic flow from pressure in humans using a nonlinear, three-element model. J Appl Physiol 74 (1993) 2566-2573
17. Langewouters G.J., Wesseling K.H., and Goedhard W.J. The static elastic properties of 45 human thoracic and 20 abdominal aortas in vitro and the parameters of a new model. J Biomech 17 (1984) 425-435
18. de Wilde R.B., Schreuder J.J., van den Berg P.C., et al. An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery. Anaesthesia 62 (2007) 760-768
19. Pitt M.S., Marshall P., Diesch J.P., et al. Cardiac output by Portapres. Clin Sci (Lond) 106 (2004) 407-412
20. van Dijk N., de Bruin I.G., Gisolf J., et al. Hemodynamic effects of leg crossing and skeletal muscle tensing during free standing in patients with vasovagal syncope. J Appl Physiol 98 (2005) 584-590
21. Harms M.P., Wesseling K.H., Pott F., et al. Continuous stroke volume monitoring by modelling flow from non-invasive measurement of arterial pressure in humans under orthostatic stress. Clin Sci (Lond) 97 (1999) 291-301
22. van Lieshout J.J., Toska K., van Lieshout E.J., et al. Beat-to-beat noninvasive stroke volume from arterial pressure and Doppler ultrasound. Eur J Appl Physiol 90 (2003) 131-137
23. Jellema W.T., Wesseling K.H., Groeneveld A.B., et al. Continuous cardiac output in septic shock by simulating a model of the aortic input impedance: a comparison with bolus injection thermodilution. Anesthesiology 90 (1999) 1317-1328
24. Dietz N.M., Halliwill J.R., Spielmann J.M., et al. Sympathetic withdrawal and forearm vasodilation during vasovagal syncope in humans. J Appl Physiol 82 (1997) 1785-1793
25. Jardine D.L., Melton I.C., Crozier I.G., et al. Decrease in cardiac output and muscle sympathetic activity during vasovagal syncope. Am J Physiol Heart Circ Physiol 282 (2002) H1804-H1809
26. Hirsch A.T., Levenson D.J., Cutler S.S., et al. Regional vascular responses to prolonged lower body negative pressure in normal subjects. Am J Physiol 257 (1989) 219-225
27. Murray R.H., Thompson L.J., Bowers J.A., et al. Hemodynamic effects of graded hypovolemia and vasodepressor syncope induced by lower body negative pressure. Am Heart J 76 (1968) 799-811
28. el Bedawi K.M., and Hainsworth R. Combined head-up tilt and lower body suction: a test of orthostatic tolerance. Clin Auton Res 4 (1994) 41-47
29. Fucà G., Dinelli M., Suzzani P., et al. The venous system is the main determinant of hypotension in patients with vasovagal syncope. Europace 8 (2006) 839-845
30. Manyari D.E., Rose S., Tyberg J.V., et al. Abnormal reflex venous function in patients with neuromediated syncope. J Am Coll Cardiol 27 (1996) 1730-1735
31. Stewart J.M., McLeod K.J., Sanyal S., et al. Relation of postural vasovagal syncope to splanchnic hypervolemia in adolescents. Circulation 110 (2004) 2575-2581
32. Hatanaka T., Potts J.T., and Shoukas A.A. Invariance of the resistance to venous return to carotid sinus baroreflex control. Am J Physiol 271 (1996) 1022-1030
33. Hildebrandt W., Gunga H.C., Herrmann J., et al. Enhanced slow caudal fluid shifts in orthostatic intolerance after 24-h bed-rest. Eur J Appl Physiol Occup Physiol 69 (1994) 61-70
34. Greene M.A., Boltax A.J., and Ulberg R.J. Cardiovascular dynamics of vasovagal reactions in man. Circ Res 9 (1961) 12-17
35. Mitro P., and Hijova E. Myocardial contractility and cardiac filling measured by impedance cardiography in patients with nitroglycerine-induced vasovagal syncope. Pacing Clin Electrophysiol 29 (2006) 1-8
36. Woltjer H.H., Bogaard H.J., and de Vries P.M. The technique of impedance cardiography. Eur Heart J 18 (1997) 1396-1403