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Yohimbine in neurally mediated syncope. Pathophysiological implications

R Mosqueda-Garcia1, R Fernandez-Violante, J Tank

  • 1The Syncope Service in the Autonomic Dysfunction Unit, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.

The Journal of Clinical Investigation
|November 20, 1998
PubMed
Summary
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Increased sympathetic activity is not always required for neurally mediated syncope (NMS). Enhancing sympathetic tone with yohimbine prevented syncope in most NMS patients, suggesting a potential treatment.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Neurally mediated syncope (NMS) is a common condition.
  • The role of sympathetic stimulation in NMS development is debated.
  • Tilt-table testing is used to diagnose syncope.

Purpose of the Study:

  • To investigate if increased sympathetic stimulation is essential for neurally mediated syncope (NMS).
  • To evaluate the effect of manipulating sympathetic outflow on tilt-induced syncope.
  • To assess the therapeutic potential of yohimbine in NMS.

Main Methods:

  • Eight NMS patients and eight controls underwent tilt-table tests.
  • Subjects received clonidine (CLO) or yohimbine (YHO) to alter sympathetic tone.
  • Intraarterial blood pressure, EKG, and muscle sympathetic nerve activity (MSNA) were monitored.

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Main Results:

  • All NMS patients experienced syncope during basal tilts.
  • Clonidine (reducing sympathetic tone) decreased tilt tolerance in controls and NMS patients.
  • Yohimbine (increasing sympathetic tone) prevented syncope in 7/8 NMS patients and increased MSNA.

Conclusions:

  • Increased sympathetic activity is not a prerequisite for NMS development.
  • Enhancing sympathetic tone with yohimbine improves orthostatic tolerance in NMS patients.
  • Yohimbine may be a potential therapeutic agent for treating NMS.