[Evaluation of beta-adrenergic blockader therapy in vasovagal syncope reproduced by head-up tilt test].
Increased sympathetic tone is one physiopathological mechanism of vasovagal syncope. In this case, betablocker therapy is logical. The reports in the literature suggest that the head-up tilt test can reliably reproduce vasovagal syncope. Ten patients (4 men and 6 women, mean age 59 +/- 18 years) who suffered from recurrent vasovagal syncopes (2 to 10 attacks in 6 patients and more than 10 in the other 4) with a positive initial head-up tilt test (syncope or severe dizziness with marked hypotension after a maximum of 40 minutes at 60 degrees) were treated with atenolol (200 mg daily in 7 cases and 100 mg daily in the other 3). A second head-up tilt test was performed 15 +/- 6 days later under betablocker therapy; this test was negative in 7 and remained positive in 3 cases. Irrespective of the result, the 10 patients followed the same therapy at the same dosage. After 9 +/- 5 months, 3 patients had another syncopal attack; 2 stopped taking their medication and the third patient continued the betablocker because there was a marked reduction in the frequency of his attacks. There were no further syncopal episodes during follow-up of the other 7 patients. The medium-term efficacy could not be predicted from the results of the second head-up tilt test. The following conclusions may be drawn from this study: The head-up tilt test becomes negative in 70% of cases after introducing betablocker therapy, assuming a 100% reproductivity. This treatment is effective in over half the patients at medium term and should be considered in patients with recurrent vasovagal syncope.
Service de cardiologie Himbert, hôpital Morvan, CHU Brest.
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006257:Head; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture; D013575:Syncope / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014630:Vagus Nerve / Q000503:physiopathology*
D000319:Adrenergic beta-Antagonists
Evaluation du traitement bêtabloquant dans les syncopes vasovagales reproduites par le test d'inclinaison.