Neurally mediated syncope: Pathogenesis, diagnosis, and treatment

Horacio Kaufmann; D. D. Savage; L. Corwin; D. L. McGee; H. E. Gendelman; M. Linzer; M. Gabelman; S. C. Day; E. F. Cook; H. Funkenstein; T. Lewis; M. G. Ziegler; C. R. Lake; I. J. Kopin; R. Bannister; P. Sever; M. Gross; E. Oribe; S. Winters; S. Winters; J. F. Sneddon; P. J. Counihan; Y. Bashir; H. Boudoulas; A. M. Weissler; R. P. Lewis; S. Weiss; J. P. Baker; T. C. Dehn; C. A. Morley; R. Sutton; C. J. Mathias; E. Armstrong; N. Browse; E. C. Shaw; H. H. Young; W. N. Kapoor; J. R. Peterson; M. Karpf; E. D. Palmer; A. L. Mark; F. M. Abboud; B. Oberg; P. Thoren; P. Thoren; J. O. Skarphedinsson; S. Carlsson; A. Jarisch; Y. Zotterman; Y. Shalev; R. Gal; P. J. Tchou; E. Oribe; S. Vissing; U. Scherrer; S. Vissing; B. J. Morgan; A. P. Fitzpatrick; N. Bannder; A. Cheng; T. D. Maloney; F. J. Jaeger; F. M. Fouad-Tarazi; S. Milstein; J. Buetikofer; J. Lesser; J. S. Sra; M. R. Jazayeri; B. Avitall; H. Barcroft; O. G. Edholm; H. Barcroft; J. McMichael; E. P. Sharpey-Shafer; S. E. Epstein; M. Stampfer; D. Beiser; R. H. Murray; L. J. Thompson; J. A. Bowers; B. G. Wallin; G. Sundlof; B. G. Wallin; C. E. Westerberg; G. Sundloff; D. Burke; G. Sundloff; G. Wallin; E. Oribe; E. Oribe; J. A. Oliver; A. D.M. Greenfield; E. Oribe; M. Miller; W. E. Glover; A. D.M. Greenfield; R. G. Shanks; B. J. Robinson; R. H. Johnson; D. Robertson; G. A. Johnson; R. M. Robertson; R. M. Palmer; D. S. Ashton; S. Moncada; S. Moncada; R. M. Palmer; E. A. Higgs; V. Bolotina; S. Najibi; J. Palacino; J. Tolins; R. M.J. Palmer; S. Moncada; J. Bayliss; J. Berman; E. Oribe; R. A. Kenny; A. Ingram; J. Bayliss; A. Fitzpatrick; R. Sutton; F. Abi-Samra; J. D. Maloney; F. Fouad-Tarazi; A. Almquist; I. F. Goldenberg; S. Milstein; A. Raviele; E. Oribe; S. Winters; B. Strasberg; E. Rechavia; A. Sagie; A. Raviele; G. Gasparini; F. Di Pede; B. P. Grubb; P. Temsey-Armos; H. Hahn; M. Brignole; C. Menozzi; L. Gianfranchi; J. S. Sra; A. J. Anderson; S. H. Sheik; R. Sheldon; S. Killam; M. B. Waxman; L. Yao; D. A. Cameron; W. N. Kapoor; N. Brant; A. Raviele; G. Gasparini; F. Di Pede; G. Micieli; A. Cavallini; C. Tasorelli; K. M. El-Bedawi; R. Hainsworth; E. Oribe; M. C. Allen; S. Winters; I. B. Davies; R. Bannister; P. S. Sever; S. Balaji; P. C. Oslizlok; M. C. Allen; D. Dacosta; S. McIntosh; R. A. Kenny; M. D. Thames; F. M. Abi Samra; N. M. Davison; R. D. Gardner; A. S. O'marcaigh; S. G. MacLellan-Tobert; C. J. Porter; M. I. Dangovian; R. Jarandilla; H. Frumin; S. Milstein; J. Buetikofer; J. Lesser; C. A. Morillo; J. W. Leitch; R. Yee; C. J. McLaran; B. J. Gersh; M. J. Osborn; S. Nelson; M. Stanley; C. Love; A. Susmano; A. S. Volgman; T. A. Buckingham; M. J. Strieper; R. Campbell; B. P. Grubb; D. Wolfe; D. Samoil

Neurally mediated syncope: Pathogenesis, diagnosis, and treatment

Horacio Kaufmann^*, D. D. Savage, L. Corwin, D. L. McGee, H. E. Gendelman, M. Linzer, M. Gabelman, S. C. Day, E. F. Cook, H. Funkenstein, T. Lewis, M. G. Ziegler, C. R. Lake, I. J. Kopin, R. Bannister, P. Sever, M. Gross, E. Oribe, S. Winters, S. WintersJ. F. Sneddon, P. J. Counihan, Y. Bashir, H. Boudoulas, A. M. Weissler, R. P. Lewis, S. Weiss, J. P. Baker, T. C. Dehn, C. A. Morley, R. Sutton, C. J. Mathias, E. Armstrong, N. Browse, E. C. Shaw, H. H. Young, W. N. Kapoor, J. R. Peterson, M. Karpf, E. D. Palmer, A. L. Mark, F. M. Abboud, B. Oberg, P. Thoren, P. Thoren, J. O. Skarphedinsson, S. Carlsson, A. Jarisch, Y. Zotterman, Y. Shalev, R. Gal, P. J. Tchou, E. Oribe, S. Vissing, U. Scherrer, S. Vissing, B. J. Morgan, A. P. Fitzpatrick, N. Bannder, A. Cheng, T. D. Maloney, F. J. Jaeger, F. M. Fouad-Tarazi, S. Milstein, J. Buetikofer, J. Lesser, J. S. Sra, M. R. Jazayeri, B. Avitall, H. Barcroft, O. G. Edholm, H. Barcroft, J. McMichael, E. P. Sharpey-Shafer, S. E. Epstein, M. Stampfer, D. Beiser, R. H. Murray, L. J. Thompson, J. A. Bowers, B. G. Wallin, G. Sundlof, B. G. Wallin, C. E. Westerberg, G. Sundloff, D. Burke, G. Sundloff, G. Wallin, E. Oribe, E. Oribe, J. A. Oliver, A. D.M. Greenfield, E. Oribe, M. Miller, W. E. Glover, A. D.M. Greenfield, R. G. Shanks, B. J. Robinson, R. H. Johnson, D. Robertson, G. A. Johnson, R. M. Robertson, R. M. Palmer, D. S. Ashton, S. Moncada, S. Moncada, R. M. Palmer, E. A. Higgs, V. Bolotina, S. Najibi, J. Palacino, J. Tolins, R. M.J. Palmer, S. Moncada, J. Bayliss, J. Berman, E. Oribe, R. A. Kenny, A. Ingram, J. Bayliss, A. Fitzpatrick, R. Sutton, F. Abi-Samra, J. D. Maloney, F. Fouad-Tarazi, A. Almquist, I. F. Goldenberg, S. Milstein, A. Raviele, E. Oribe, S. Winters, B. Strasberg, E. Rechavia, A. Sagie, A. Raviele, G. Gasparini, F. Di Pede, B. P. Grubb, P. Temsey-Armos, H. Hahn, M. Brignole, C. Menozzi, L. Gianfranchi, J. S. Sra, A. J. Anderson, S. H. Sheik, R. Sheldon, S. Killam, M. B. Waxman, L. Yao, D. A. Cameron, W. N. Kapoor, N. Brant, A. Raviele, G. Gasparini, F. Di Pede, G. Micieli, A. Cavallini, C. Tasorelli, K. M. El-Bedawi, R. Hainsworth, E. Oribe, M. C. Allen, S. Winters, I. B. Davies, R. Bannister, P. S. Sever, S. Balaji, P. C. Oslizlok, M. C. Allen, D. Dacosta, S. McIntosh, R. A. Kenny, M. D. Thames, F. M. Abi Samra, N. M. Davison, R. D. Gardner, A. S. O'marcaigh, S. G. MacLellan-Tobert, C. J. Porter, M. I. Dangovian, R. Jarandilla, H. Frumin, S. Milstein, J. Buetikofer, J. Lesser, C. A. Morillo, J. W. Leitch, R. Yee, C. J. McLaran, B. J. Gersh, M. J. Osborn, S. Nelson, M. Stanley, C. Love, A. Susmano, A. S. Volgman, T. A. Buckingham, M. J. Strieper, R. Campbell, B. P. Grubb, D. Wolfe, D. Samoil

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

104 Scopus citations

Abstract

Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.

Original language	English
Pages (from-to)	S12-S18
Journal	Neurology
Volume	45
Issue number	4
State	Published - 1 Apr 1995
Externally published	Yes

Funding

Funders	Funder number
National Center for Research Resources	M01RR000071

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Cite this

Kaufmann, H., Savage, D. D., Corwin, L., McGee, D. L., Gendelman, H. E., Linzer, M., Gabelman, M., Day, S. C., Cook, E. F., Funkenstein, H., Lewis, T., Ziegler, M. G., Lake, C. R., Kopin, I. J., Bannister, R., Sever, P., Gross, M., Oribe, E., Winters, S., ... Samoil, D. (1995). Neurally mediated syncope: Pathogenesis, diagnosis, and treatment. Neurology, 45(4), S12-S18.

@article{a4f2102309924577a16f2618b13dbda1,

title = "Neurally mediated syncope: Pathogenesis, diagnosis, and treatment",

abstract = "Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.",

author = "Horacio Kaufmann and Savage, {D. D.} and L. Corwin and McGee, {D. L.} and Gendelman, {H. E.} and M. Linzer and M. Gabelman and Day, {S. C.} and Cook, {E. F.} and H. Funkenstein and T. Lewis and Ziegler, {M. G.} and Lake, {C. R.} and Kopin, {I. J.} and R. Bannister and P. Sever and M. Gross and E. Oribe and S. Winters and S. Winters and Sneddon, {J. F.} and Counihan, {P. J.} and Y. Bashir and H. Boudoulas and Weissler, {A. M.} and Lewis, {R. P.} and S. Weiss and Baker, {J. P.} and Dehn, {T. C.} and Morley, {C. A.} and R. Sutton and Mathias, {C. J.} and E. Armstrong and N. Browse and Shaw, {E. C.} and Young, {H. H.} and Kapoor, {W. N.} and Peterson, {J. R.} and M. Karpf and Palmer, {E. D.} and Mark, {A. L.} and Abboud, {F. M.} and B. Oberg and P. Thoren and P. Thoren and Skarphedinsson, {J. O.} and S. Carlsson and A. Jarisch and Y. Zotterman and Y. Shalev and R. Gal and Tchou, {P. J.} and E. Oribe and S. Vissing and U. Scherrer and S. Vissing and Morgan, {B. J.} and Fitzpatrick, {A. P.} and N. Bannder and A. Cheng and Maloney, {T. D.} and Jaeger, {F. J.} and Fouad-Tarazi, {F. M.} and S. Milstein and J. Buetikofer and J. Lesser and Sra, {J. S.} and Jazayeri, {M. R.} and B. Avitall and H. Barcroft and Edholm, {O. G.} and H. Barcroft and J. McMichael and Sharpey-Shafer, {E. P.} and Epstein, {S. E.} and M. Stampfer and D. Beiser and Murray, {R. H.} and Thompson, {L. J.} and Bowers, {J. A.} and Wallin, {B. G.} and G. Sundlof and Wallin, {B. G.} and Westerberg, {C. E.} and G. Sundloff and D. Burke and G. Sundloff and G. Wallin and E. Oribe and E. Oribe and Oliver, {J. A.} and Greenfield, {A. D.M.} and E. Oribe and M. Miller and Glover, {W. E.} and Greenfield, {A. D.M.} and Shanks, {R. G.} and Robinson, {B. J.} and Johnson, {R. H.} and D. Robertson and Johnson, {G. A.} and Robertson, {R. M.} and Palmer, {R. M.} and Ashton, {D. S.} and S. Moncada and S. Moncada and Palmer, {R. M.} and Higgs, {E. A.} and V. Bolotina and S. Najibi and J. Palacino and J. Tolins and Palmer, {R. M.J.} and S. Moncada and J. Bayliss and J. Berman and E. Oribe and Kenny, {R. A.} and A. Ingram and J. Bayliss and A. Fitzpatrick and R. Sutton and F. Abi-Samra and Maloney, {J. D.} and F. Fouad-Tarazi and A. Almquist and Goldenberg, {I. F.} and S. Milstein and A. Raviele and E. Oribe and S. Winters and B. Strasberg and E. Rechavia and A. Sagie and A. Raviele and G. Gasparini and {Di Pede}, F. and Grubb, {B. P.} and P. Temsey-Armos and H. Hahn and M. Brignole and C. Menozzi and L. Gianfranchi and Sra, {J. S.} and Anderson, {A. J.} and Sheik, {S. H.} and R. Sheldon and S. Killam and Waxman, {M. B.} and L. Yao and Cameron, {D. A.} and Kapoor, {W. N.} and N. Brant and A. Raviele and G. Gasparini and {Di Pede}, F. and G. Micieli and A. Cavallini and C. Tasorelli and El-Bedawi, {K. M.} and R. Hainsworth and E. Oribe and Allen, {M. C.} and S. Winters and Davies, {I. B.} and R. Bannister and Sever, {P. S.} and S. Balaji and Oslizlok, {P. C.} and Allen, {M. C.} and D. Dacosta and S. McIntosh and Kenny, {R. A.} and Thames, {M. D.} and {Abi Samra}, {F. M.} and Davison, {N. M.} and Gardner, {R. D.} and O'marcaigh, {A. S.} and MacLellan-Tobert, {S. G.} and Porter, {C. J.} and Dangovian, {M. I.} and R. Jarandilla and H. Frumin and S. Milstein and J. Buetikofer and J. Lesser and Morillo, {C. A.} and Leitch, {J. W.} and R. Yee and McLaran, {C. J.} and Gersh, {B. J.} and Osborn, {M. J.} and S. Nelson and M. Stanley and C. Love and A. Susmano and Volgman, {A. S.} and Buckingham, {T. A.} and Strieper, {M. J.} and R. Campbell and Grubb, {B. P.} and D. Wolfe and D. Samoil",

year = "1995",

month = apr,

day = "1",

language = "אנגלית",

volume = "45",

pages = "S12--S18",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

Kaufmann, H, Savage, DD, Corwin, L, McGee, DL, Gendelman, HE, Linzer, M, Gabelman, M, Day, SC, Cook, EF, Funkenstein, H, Lewis, T, Ziegler, MG, Lake, CR, Kopin, IJ, Bannister, R, Sever, P, Gross, M, Oribe, E, Winters, S, Winters, S, Sneddon, JF, Counihan, PJ, Bashir, Y, Boudoulas, H, Weissler, AM, Lewis, RP, Weiss, S, Baker, JP, Dehn, TC, Morley, CA, Sutton, R, Mathias, CJ, Armstrong, E, Browse, N, Shaw, EC, Young, HH, Kapoor, WN, Peterson, JR, Karpf, M, Palmer, ED, Mark, AL, Abboud, FM, Oberg, B, Thoren, P, Thoren, P, Skarphedinsson, JO, Carlsson, S, Jarisch, A, Zotterman, Y, Shalev, Y, Gal, R, Tchou, PJ, Oribe, E, Vissing, S, Scherrer, U, Vissing, S, Morgan, BJ, Fitzpatrick, AP, Bannder, N, Cheng, A, Maloney, TD, Jaeger, FJ, Fouad-Tarazi, FM, Milstein, S, Buetikofer, J, Lesser, J, Sra, JS, Jazayeri, MR, Avitall, B, Barcroft, H, Edholm, OG, Barcroft, H, McMichael, J, Sharpey-Shafer, EP, Epstein, SE, Stampfer, M, Beiser, D, Murray, RH, Thompson, LJ, Bowers, JA, Wallin, BG, Sundlof, G, Wallin, BG, Westerberg, CE, Sundloff, G, Burke, D, Sundloff, G, Wallin, G, Oribe, E, Oribe, E, Oliver, JA, Greenfield, ADM, Oribe, E, Miller, M, Glover, WE, Greenfield, ADM, Shanks, RG, Robinson, BJ, Johnson, RH, Robertson, D, Johnson, GA, Robertson, RM, Palmer, RM, Ashton, DS, Moncada, S, Moncada, S, Palmer, RM, Higgs, EA, Bolotina, V, Najibi, S, Palacino, J, Tolins, J, Palmer, RMJ, Moncada, S, Bayliss, J, Berman, J, Oribe, E, Kenny, RA, Ingram, A, Bayliss, J, Fitzpatrick, A, Sutton, R, Abi-Samra, F, Maloney, JD, Fouad-Tarazi, F, Almquist, A, Goldenberg, IF, Milstein, S, Raviele, A, Oribe, E, Winters, S, Strasberg, B , Rechavia, E, Sagie, A, Raviele, A, Gasparini, G, Di Pede, F, Grubb, BP, Temsey-Armos, P, Hahn, H, Brignole, M, Menozzi, C, Gianfranchi, L, Sra, JS, Anderson, AJ, Sheik, SH, Sheldon, R, Killam, S, Waxman, MB, Yao, L, Cameron, DA, Kapoor, WN, Brant, N, Raviele, A, Gasparini, G, Di Pede, F, Micieli, G, Cavallini, A, Tasorelli, C, El-Bedawi, KM, Hainsworth, R, Oribe, E, Allen, MC, Winters, S, Davies, IB, Bannister, R, Sever, PS, Balaji, S, Oslizlok, PC, Allen, MC, Dacosta, D, McIntosh, S, Kenny, RA, Thames, MD, Abi Samra, FM, Davison, NM, Gardner, RD, O'marcaigh, AS, MacLellan-Tobert, SG, Porter, CJ, Dangovian, MI, Jarandilla, R, Frumin, H, Milstein, S, Buetikofer, J, Lesser, J, Morillo, CA, Leitch, JW, Yee, R, McLaran, CJ, Gersh, BJ, Osborn, MJ, Nelson, S, Stanley, M, Love, C, Susmano, A, Volgman, AS, Buckingham, TA, Strieper, MJ, Campbell, R, Grubb, BP, Wolfe, D & Samoil, D 1995, 'Neurally mediated syncope: Pathogenesis, diagnosis, and treatment', Neurology, vol. 45, no. 4, pp. S12-S18.

TY - JOUR

T1 - Neurally mediated syncope

T2 - Pathogenesis, diagnosis, and treatment

AU - Kaufmann, Horacio

AU - Savage, D. D.

AU - Corwin, L.

AU - McGee, D. L.

AU - Gendelman, H. E.

AU - Linzer, M.

AU - Gabelman, M.

AU - Day, S. C.

AU - Cook, E. F.

AU - Funkenstein, H.

AU - Lewis, T.

AU - Ziegler, M. G.

AU - Lake, C. R.

AU - Kopin, I. J.

AU - Bannister, R.

AU - Sever, P.

AU - Gross, M.

AU - Oribe, E.

AU - Winters, S.

AU - Sneddon, J. F.

AU - Counihan, P. J.

AU - Bashir, Y.

AU - Boudoulas, H.

AU - Weissler, A. M.

AU - Lewis, R. P.

AU - Weiss, S.

AU - Baker, J. P.

AU - Dehn, T. C.

AU - Morley, C. A.

AU - Sutton, R.

AU - Mathias, C. J.

AU - Armstrong, E.

AU - Browse, N.

AU - Shaw, E. C.

AU - Young, H. H.

AU - Kapoor, W. N.

AU - Peterson, J. R.

AU - Karpf, M.

AU - Palmer, E. D.

AU - Mark, A. L.

AU - Abboud, F. M.

AU - Oberg, B.

AU - Thoren, P.

AU - Skarphedinsson, J. O.

AU - Carlsson, S.

AU - Jarisch, A.

AU - Zotterman, Y.

AU - Shalev, Y.

AU - Gal, R.

AU - Tchou, P. J.

AU - Oribe, E.

AU - Vissing, S.

AU - Scherrer, U.

AU - Vissing, S.

AU - Morgan, B. J.

AU - Fitzpatrick, A. P.

AU - Bannder, N.

AU - Cheng, A.

AU - Maloney, T. D.

AU - Jaeger, F. J.

AU - Fouad-Tarazi, F. M.

AU - Milstein, S.

AU - Buetikofer, J.

AU - Lesser, J.

AU - Sra, J. S.

AU - Jazayeri, M. R.

AU - Avitall, B.

AU - Barcroft, H.

AU - Edholm, O. G.

AU - Barcroft, H.

AU - McMichael, J.

AU - Sharpey-Shafer, E. P.

AU - Epstein, S. E.

AU - Stampfer, M.

AU - Beiser, D.

AU - Murray, R. H.

AU - Thompson, L. J.

AU - Bowers, J. A.

AU - Wallin, B. G.

AU - Sundlof, G.

AU - Wallin, B. G.

AU - Westerberg, C. E.

AU - Sundloff, G.

AU - Burke, D.

AU - Sundloff, G.

AU - Wallin, G.

AU - Oribe, E.

AU - Oliver, J. A.

AU - Greenfield, A. D.M.

AU - Oribe, E.

AU - Miller, M.

AU - Glover, W. E.

AU - Greenfield, A. D.M.

AU - Shanks, R. G.

AU - Robinson, B. J.

AU - Johnson, R. H.

AU - Robertson, D.

AU - Johnson, G. A.

AU - Robertson, R. M.

AU - Palmer, R. M.

AU - Ashton, D. S.

AU - Moncada, S.

AU - Palmer, R. M.

AU - Higgs, E. A.

AU - Bolotina, V.

AU - Najibi, S.

AU - Palacino, J.

AU - Tolins, J.

AU - Palmer, R. M.J.

AU - Moncada, S.

AU - Bayliss, J.

AU - Berman, J.

AU - Oribe, E.

AU - Kenny, R. A.

AU - Ingram, A.

AU - Bayliss, J.

AU - Fitzpatrick, A.

AU - Sutton, R.

AU - Abi-Samra, F.

AU - Maloney, J. D.

AU - Fouad-Tarazi, F.

AU - Almquist, A.

AU - Goldenberg, I. F.

AU - Milstein, S.

AU - Raviele, A.

AU - Oribe, E.

AU - Winters, S.

AU - Strasberg, B.

AU - Rechavia, E.

AU - Sagie, A.

AU - Raviele, A.

AU - Gasparini, G.

AU - Di Pede, F.

AU - Grubb, B. P.

AU - Temsey-Armos, P.

AU - Hahn, H.

AU - Brignole, M.

AU - Menozzi, C.

AU - Gianfranchi, L.

AU - Sra, J. S.

AU - Anderson, A. J.

AU - Sheik, S. H.

AU - Sheldon, R.

AU - Killam, S.

AU - Waxman, M. B.

AU - Yao, L.

AU - Cameron, D. A.

AU - Kapoor, W. N.

AU - Brant, N.

AU - Raviele, A.

AU - Gasparini, G.

AU - Di Pede, F.

AU - Micieli, G.

AU - Cavallini, A.

AU - Tasorelli, C.

AU - El-Bedawi, K. M.

AU - Hainsworth, R.

AU - Oribe, E.

AU - Allen, M. C.

AU - Winters, S.

AU - Davies, I. B.

AU - Bannister, R.

AU - Sever, P. S.

AU - Balaji, S.

AU - Oslizlok, P. C.

AU - Allen, M. C.

AU - Dacosta, D.

AU - McIntosh, S.

AU - Kenny, R. A.

AU - Thames, M. D.

AU - Abi Samra, F. M.

AU - Davison, N. M.

AU - Gardner, R. D.

AU - O'marcaigh, A. S.

AU - MacLellan-Tobert, S. G.

AU - Porter, C. J.

AU - Dangovian, M. I.

AU - Jarandilla, R.

AU - Frumin, H.

AU - Milstein, S.

AU - Buetikofer, J.

AU - Lesser, J.

AU - Morillo, C. A.

AU - Leitch, J. W.

AU - Yee, R.

AU - McLaran, C. J.

AU - Gersh, B. J.

AU - Osborn, M. J.

AU - Nelson, S.

AU - Stanley, M.

AU - Love, C.

AU - Susmano, A.

AU - Volgman, A. S.

AU - Buckingham, T. A.

AU - Strieper, M. J.

AU - Campbell, R.

AU - Grubb, B. P.

AU - Wolfe, D.

AU - Samoil, D.

PY - 1995/4/1

Y1 - 1995/4/1

N2 - Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.

AB - Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.

UR - http://www.scopus.com/inward/record.url?scp=0029285108&partnerID=8YFLogxK

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C2 - 7746368

AN - SCOPUS:0029285108

SN - 0028-3878

VL - 45

SP - S12-S18

JO - Neurology

JF - Neurology

IS - 4

ER -

Neurally mediated syncope: Pathogenesis, diagnosis, and treatment

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