Observations on midodrine in a case of vasodepressor neurogenic syncope.
A 43-year-old man presented with recurrent syncope and dizziness after he had a dual chamber pacemaker fitted for presumed sino-atrial disease. Head-up tilt produced vasodepressor neurocardiogenic syncope, despite appropriate heart rate support during pacing, and reproduced symptoms. Symptoms were not improved by disopyramide. A double-blind cross-over trial of midodrine, an alpha-receptor agonist, was effective in reducing symptoms: it abolished syncope and reduced frequency and severity of dizziness, coupled with improved haemodynamic responses to head-up tilt.
Ward
C
C
Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Kenny
R A
RA
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002304:Cardiac Pacing, Artificial; D018592:Cross-Over Studies; D004562:Electrocardiography; D018475:Head-Down Tilt; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008879:Midodrine / Q000627:therapeutic use*; D012008:Recurrence; D013575:Syncope / Q000188:drug therapy* / Q000503:physiopathology; D014655:Vascular Resistance / Q000187:drug effects
D000316:Adrenergic alpha-Agonists; D008879:Midodrine