A case of neurally mediated syncope induced by laughter successfully treated with combination of propranolol and midodrine.
A 69-year-old man had been suffering from recurrent syncope induced by laughter since the age of 58. His syncope was reproduced by head-up tilt testing with isoproterenol infusion and we concluded that his laughter-induced syncope was one type of neurally mediated syndrome (NMS). His daughter also had NMS and her syncope was treated with propranolol. Propranolol and midodrine hydrochloride, an alpha(1)-adrenergic stimulant, were effective at preventing his laughter-induced syncope. This is a case report of laughter-induced syncope with a familial predisposition successfully treated with the combination of the nonselective beta-blocker propranolol and the alpha(1)-stimulator midodrine.
Amaki
Makoto
M
Division of Hypertension and Nephrology, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
Kamide
Kei
K
Takiuchi
Shin
S
Niizuma
Shinichiro
S
Horio
Takeshi
T
Kawano
Yuhei
Y
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007845:Laughter; D008297:Male; D008879:Midodrine / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*; D012008:Recurrence; D019462:Syncope, Vasovagal / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
D000316:Adrenergic alpha-Agonists; D000319:Adrenergic beta-Antagonists; D008879:Midodrine; D011433:Propranolol