Haemodynamic changes early in prodromal symptoms of vasovagal syncope.
OBJECTIVE
Vasovagal syncope (VVS) is often preceded by prodromal symptoms. The haemodynamic changes occurring during the prodrome have not been systematically investigated. The aim of the present study was to investigate the behaviour of blood pressure (BP), heart rate (HR) and sympathetic activity at the beginning of the prodrome in patients with tilt-induced VVS.


RESULTS
Sixty-three patients with VVS underwent tilt testing. BP and HR were measured and blood samples for plasma catecholamine determination were obtained during the test. Twenty-seven patients developed syncope of whom all had a prodrome. From the last scheduled measurement before prodromal symptoms to the beginning of the prodrome, both systolic and diastolic BP decreased in all patients (from 105 +/- 16 to 74 +/- 20 mmHg, P<0.001, and from 68 +/- 13 to 51 +/- 12 mmHg, P<0 001, respectively) and HR decreased in 18 (67%) (from 89 +/- 22 to 80 +/- 25 beats/ min P<0 02). At the onset of loss of consciousness both BP and HR showed a further decrease (P<0.001). Plasma adrenaline significantly increased from the last sample before prodromal symptoms to the beginning of the prodrome (P<0.01) and showed a further increase during loss of consciousness (P<0.05), whereas plasma noradrenaline did not increase, as an expression of inhibition of sympathetic neural outflow.


CONCLUSIONS
These results demonstrate that in patients with tilt-induced VVS, BP is consistently decreased at the beginning of prodromal symptoms because of the withdrawal of sympathetic activity, and HR is often reduced, probably because of increased vagal activity. We may infer that similar haemodynamic features also occur during spontaneous VVS.
Alboni
P
P
Division of Cardiology, Ospedale Civile, Cento Fe, Italy. p.alboni@ausl.fe.it
Dinelli
M
M
Gruppillo
P
P
Bondanelli
M
M
Bettiol
K
K
Marchi
P
P
degli
Uberti E C
UE
D000328:Adult; D001794:Blood Pressure; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D013564:Sympathetic Nervous System / Q000503:physiopathology; D019462:Syncope, Vasovagal / Q000097:blood / Q000503:physiopathology*; D018667:Tilt-Table Test
D009638:Norepinephrine; D004837:Epinephrine