A patient responding to combined therapy with pirmenol and midodrine for refractory neurally mediated syncope complicated by prostatic hypertrophy.
A 67-year-old man with neurally mediated syncope (NMS) complicated by prostatic hypertrophy responded well to combined therapy with pirmenol and midodrine. In 2003, syncope occurred while the patient was driving a car. Results of head-up tilt-table testing (HUT) suggested a mixed type of NMS. Oral administration of disopyramide provided severe urinary obstruction. Pirmenol treatment was not associated with syncope during ordinary HUT, but nausea, sweating, and syncope occurred during HUT with provocative administration of isosorbide dinitrate. Combined therapy with pirmenol and midodrine avoided syncope during HUT, and has prevented attacks since discharge from the hospital.
Mizuguchi
Yukio
Y
Cardiovascular Section, Higashi Tokushima National Hospital, National Hospital Organization, 1-1 Ohmukai-Kita, Ohtera, Itano, Tokushima 779-0193, Japan. mizuguchi@higasitokusima.hosp.go.jp
Ishimoto
Takeo
T
Kageyama
Norihito
N
Oishi
Yoshifumi
Y
Emi
Shigefumi
S
Nagase
Norio
N
Oki
Takashi
T
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008879:Midodrine / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D011470:Prostatic Hyperplasia / Q000150:complications; D019462:Syncope, Vasovagal / Q000150:complications / Q000188:drug therapy*; D018667:Tilt-Table Test; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D010880:Piperidines; D014662:Vasoconstrictor Agents; D008879:Midodrine; C024318:pirmenol