Related Experiment Videos
Vasodepressor syncope due to subclinical myocardial ischemia
D D Ascheim1, S M Markowitz, H Lai
1Department of Medicine, New York Hospital--Cornell Medical Center, New York 10021, USA.
Journal of Cardiovascular Electrophysiology
|February 1, 1997
Summary
Myocardial ischemia, including silent ischemia, can trigger vasodepressor syncope. These findings suggest a new cause for fainting spells, potentially linked to coronary artery issues.
Area of Science:
- Cardiology
- Nephrology
Background:
- Vasodepressor syncope, a common cause of fainting, has an incompletely understood trigger.
- Myocardial ischemia from acute right coronary occlusion can cause hypotension via the Bezold-Jarisch reflex.
- An ischemic trigger for common vasodepressor syncope has not been previously identified.
Observation:
- Two patients with syncope showed evidence of myocardial ischemia during diagnostic testing.
- Patient 1 exhibited ischemic ECG changes and hypoperfusion during tilt table testing, suggesting microvascular disease.
- Patient 2 had ischemic ECG changes during exercise recovery, followed by syncope, linked to significant coronary artery stenosis.
Findings:
- Demonstrates a causal link between myocardial ischemia and vasodepressor syncope.
- Identifies subtle myocardial ischemia, including atypical angina and silent ischemia, as potential triggers.
- Tilt table testing, ECG monitoring, and advanced imaging can reveal ischemia during syncope evaluation.
Implications:
- Suggests a novel etiology for vasodepressor syncope.
- Highlights the importance of considering cardiac ischemia in unexplained syncope.
- May guide diagnostic strategies and therapeutic interventions for patients with recurrent syncope.