title: Recurrent supine syncope: an unusual manifestation of the neurally mediated faint.
abstract: BACKGROUND
  Syncope occasionally may occur in the supine patient due to severe brady- or tachyarrhythmia. However, recurrent syncope upon assumption of the supine position as a result of a neurally mediated reflex mechanism has not been reported previously.
  
  
  RESULTS
  Two young patients, both of whom had significant systemic illnesses, experienced recurrent episodes of presyncope and/or syncope shortly after assuming the supine position. During ambulatory ECG monitoring, symptoms were provoked only by lying down and were associated with transient bradycardia. Head-up tilt table testing was undertaken as part of the syncope evaluation and was nondiagnostic in both cases. However, both patients exhibited a transient cardioinhibitory response with reproduction of typical symptoms upon return of the table to the supine position ("reverse tilt"). During follow-up (8 and 14 months), both patients improved with pharmacologic treatment (disopyramide in one case and midodrine in the other).
  
  
  CONCLUSIONS
  Presyncope or syncope upon lying down can be an unusual manifestation of the neurally mediated faint.
authors.affiliation: Syncope and Cardiac Arrhythmia Centers, Department of Medicine, University of Minnesota School of Medicine, Minneapolis 55455, USA.
authors.forename: D
authors.initials: D
authors.lastname: Iskos
authors.forename: J J
authors.initials: JJ
authors.lastname: Shultz
authors.forename: D G
authors.initials: DG
authors.lastname: Benditt
mesh_terms: D000328:Adult; D004562:Electrocardiography; D006801:Humans; D008297:Male; D012008:Recurrence; D016683:Supine Position; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D018667:Tilt-Table Test; D014463:Ultrasonography