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Related Experiment Videos

Neurally-mediated syncope.

Michele Brignole1

  • 1Arrhythmologic Center, Department of Cardiology, Ospedali del Tigullio, Lavagna (GE), Italy. mbrignole@asl4.liguria.it

Italian Heart Journal : Official Journal of the Italian Federation of Cardiology
|May 7, 2005
PubMed
Summary
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Neurally-mediated syncope diagnosis and treatment vary based on reflex responses like vasodilation and bradycardia. Specific tests and tailored therapies, including tilt training and pacing, improve outcomes for recurrent or severe cases.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Medicine

Background:

  • Neurally-mediated syncope involves reflex responses causing vasodilation and/or bradycardia, leading to hypotension and cerebral hypoperfusion.
  • Distinguishing between classical vasovagal and situational syncope is possible with specific triggers and prodromal symptoms.
  • In undiagnosed cases, factors like prolonged standing, environmental triggers, and autonomic symptoms suggest a neurally-mediated cause requiring further investigation.

Purpose of the Study:

  • To outline diagnostic approaches for neurally-mediated syncope.
  • To detail therapeutic strategies based on syncope type and severity.
  • To emphasize the importance of assessing cardioinhibition and vasodepression components for effective treatment.

Main Methods:

Related Experiment Videos

  • Initial evaluation includes identifying precipitating events and prodromal symptoms for classical vasovagal and situational syncope.
  • Diagnostic confirmation involves specialized tests such as carotid sinus massage and tilt testing.
  • Assessment of cardioinhibition and vasodepression is recommended using tilt testing or implantable loop recorders.

    • Main Results:

    • Classical vasovagal syncope is linked to specific emotional or physical triggers with typical symptoms.
    • Situational syncope is associated with micturition, defecation, cough, or swallowing.
    • Carotid sinus massage and tilt testing are key diagnostic tools for neurally-mediated syncope.

    Conclusions:

    • Education and reassurance are primary treatments for most syncope cases.
    • Tilt training and counterpressure maneuvers benefit recurrent vasovagal syncope.
    • Cardiac pacing is indicated for specific cardioinhibitory syndromes or frequent, severe cardioinhibitory vasovagal syncope, while drug efficacy remains unsupported.