scholarly journals Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Nicholas L. DePace ◽  
Julie A. Bateman ◽  
Michael Yayac ◽  
John Oh ◽  
Mushfiqur Siddique ◽  
...  
Keyword(s):  
Heart Rate ◽  
Patient Outcomes ◽  
Vasovagal Syncope ◽  
Tilt Table ◽  
Subjective Assessments ◽  
Improved Outcomes ◽  
Tilt Table Testing ◽  
Subtype Differentiation ◽  
Age Range ◽  
Underlying Pathophysiology

Syncope is difficult to definitively diagnose, even with tilt-table testing and beat-to-beat blood pressure measurements, the gold-standard. Both are qualitative, subjective assessments. There are subtypes of syncope associated with autonomic conditions for which tilt-table testing is not useful. Heart rate variability analyses also include too much ambiguity. Three subtypes of syncope are differentiated: vasovagal syncope (VVS) due to parasympathetic excess (VVS-PE), VVS with abnormal heart rate response (VVS-HR), and VVS without PE (VVS-PN). P&S monitoring (ANSAR, Inc., Philadelphia, PA) differentiates subtypes in 2727 cardiology patients (50.5% female; average age: 57 years; age range: 12–100 years), serially tested over four years (3.3 tests per patient, average). P&S monitoring noninvasively, independently, and simultaneously measures parasympathetic and sympathetic (P&S) activity, including the normal P-decrease followed by an S-increase with head-up postural change (standing). Syncope, as an S-excess (SE) with stand, is differentiated from orthostatic dysfunction (e.g., POTS) as S-withdrawal with stand. Upon standing, VVS-PE is further differentiated as SE with PE, VVS-HR as SE with abnormal HR, and VVS-PN as SE with normal P- and HR-responses. Improved understanding of the underlying pathophysiology by more accurate subtyping leads to more precise therapy and improved outcomes.

scholarly journals Home Orthostatic Training In Elderly Patients With Vasovagal Syncope — A Prospective Randomised Controlled Trial

2015 ◽  
Vol 10 (2) ◽  
pp. 1
Author(s):  
Steven Podd ◽  
Jacqueline Hunt ◽  
Neil Sulke ◽  
◽  
◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Back Pain ◽  
Elderly Patients ◽  
Vasovagal Syncope ◽  
Common Reason ◽  
Randomised Control Trial ◽  
Tilt Test ◽  
Tilt Table ◽  
Tilt Table Testing

Aim: The aim of this study was to assess the effect of home orthostatic training (HOT) on autonomic reflexes in elderly patients with vasovagal syncope (VVS). Methods: Design and Setting: A single-blind randomised control trial was conducted at Eastbourne District General Hospital, East Sussex NHS Trust. Patients: Individuals with recurrent syncope underwent tilt-table testing between August 2007 and October 2009.Those with at least two syncopal episodes and tilt-test proven VVS were recruited. Participants were divided into those aged >65 years (O65) and those aged <65 years (U65). Interventions: Patients in the O65 group were randomised 1:1 to receive active HOT (O65+) or sham HOT (O65–). The U65 group received active HOT. Participants performed HOT/sham HOT and recorded their training and symptoms. Patients had a repeat tilt test at 3 months. Outcome Measures: Time to syncope at repeat tilt-table testing, low-frequency heart rate variability (LF-HRV), high-frequency heart rate variability (HF-HRV), mean upslope baroreflex sensitivity (BRS) and mean downslope BRS were assessed. Results: A total of 106 patients with recurrent syncope underwent tilt-table testing. Of these, 45 consecutive patients (30 in the O65 group and 15 in the U65 group) were recruited. Two, one and three patients withdrew or were lost-to-follow-up in the O65+, O65–, and U65 groups, respectively. Symptomatic benefit occurred in four (31 %) of the O65+, four (29 %) of the O65–, and six (50 %) of the U65. None of the autonomic measures changed significantly in any group. No difference was seen with HF-HRV, LF-HRV mean upslope BRS and mean downslope BRS. Fifty per-cent of the O65+ group stopped training because of back pain. Time constraint (25 %) was the most common reason for cessation in the U65 group. Conclusions: Despite good tilt training compliance, no improvement in autonomic measures in any group was shown. The most common reason for cessation of training was back pain in the elderly groups. This study does not support the use of HOT in elderly patients.

Spectral analysis of heart rate variability during tilt-table testing in patients with vasovagal syncope

1998 ◽  
Vol 64 (2) ◽  
pp. 185-194 ◽  
Author(s):  
G.E Kochiadakis ◽  
E.M Kanoupakis ◽  
N.E Igoumenidis ◽  
M.E Marketou ◽  
M.C Solomou ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Spectral Analysis ◽  
Vasovagal Syncope ◽  
Tilt Table ◽  
Tilt Table Testing

scholarly journals The Diagnostic Value of Cardiac Deceleration Capacity in Vasovagal Syncope

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Lihui Zheng ◽  
Wei Sun ◽  
Shangyu Liu ◽  
Erpeng Liang ◽  
Zhongpeng Du ◽  
...  
Keyword(s):  
Heart Rate ◽  
Vasovagal Syncope ◽  
Diagnostic Value ◽  
Control Group ◽  
Vagal Activity ◽  
Tilt Table Test ◽  
Tilt Table ◽  
Good Tool ◽  
Deceleration Capacity ◽  
Vagal Control

Background: Increased parasympathetic activity is thought to play important roles in syncope events of patients with vasovagal syncope (VVS). However, direct measurements of the vagal control are difficult. The novel deceleration capacity (DC) of heart rate measure has been used to characterize the vagal modulation. This study aimed to assess vagal control in patients with VVS and evaluate the diagnostic value of the DC in VVS. Methods: Altogether, 161 consecutive patients with VVS (43±15 years; 62 males) were enrolled. Tilt table test was positive in 101 and negative in 60 patients. Sixty-five healthy subjects were enrolled as controls. DC and heart rate variability in 24-hour ECG, echocardiogram, and biochemical examinations were compared between the syncope and control groups. Results: DC was significantly higher in the syncope group than in the control group (9.6±3.3 versus 6.5±2.0 ms, P <0.001). DC was similarly increased in patients with VVS with a positive and negative tilt table test (9.7±3.5 and 9.4±2.9 ms, P =0.614). In multivariable logistic regression analyses, DC was independently associated with syncope (odds ratio=1.518 [95% CI, 1.301–1.770]; P =0.0001). For the prediction of syncope, the area under curve analysis showed similar values when comparing single DC and combined DC with other risk factors ( P =0.1147). From the receiver operator characteristic curves for syncope discrimination, the optimal cutoff value for the DC was 7.12 ms. Conclusions: DC>7.5 ms may serve as a good tool to monitor cardiac vagal activity and discriminate VVS, particularly in those with negative tilt table test.

scholarly journals P6634Novel method of analysing heart rate variability at rest predicts a positive tilt table testing in patients with syncope of unknown origin

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
E Myrovali ◽  
A P Antoniadis ◽  
M Sotiriadou ◽  
C Lazaridis ◽  
C Bakogiannis ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Unknown Origin ◽  
Tilt Table ◽  
Tilt Table Testing

The Newcastle protocols 2008: an update on head-up tilt table testing and the management of vasovagal syncope and related disorders

Heart ◽  
2008 ◽  
Vol 95 (5) ◽  
pp. 416-420 ◽  
Author(s):  
S W Parry ◽  
P Reeve ◽  
J Lawson ◽  
F E Shaw ◽  
J Davison ◽  
...  
Keyword(s):  
Vasovagal Syncope ◽  
Tilt Table ◽  
Tilt Table Testing ◽  
Head Up Tilt

scholarly journals ‘Front-loaded’ head-up tilt table testing: validation of a rapid first line nitrate-provoked tilt protocol for the diagnosis of vasovagal syncope

2008 ◽  
Vol 37 (4) ◽  
pp. 411-415 ◽  
Author(s):  
Steve W. Parry ◽  
Janine C. Gray ◽  
Julia L. Newton ◽  
Pamela Reeve ◽  
Diarmuid O'shea ◽  
...  
Keyword(s):  
Vasovagal Syncope ◽  
First Line ◽  
Tilt Table ◽  
Tilt Table Testing ◽  
Head Up Tilt

Body Position Influences Cardiovascular Disgust Reactivity

2015 ◽  
Vol 29 (2) ◽  
pp. 73-79 ◽  
Author(s):  
Anne Schienle ◽  
Sonja Übel ◽  
Andreas Rössler ◽  
Andreas Schwerdtfeger ◽  
Helmut Karl Lackner
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Position ◽  
Vasovagal Syncope ◽  
Upright Position ◽  
Compensatory Mechanism ◽  
Tilt Table ◽  
Increased Risk ◽  
Disgust Proneness

It has been suggested that elevated trait disgust constitutes a vulnerability factor for fainting episodes. We tested the hypothesis that disgust-prone individuals are susceptible to vasovagal syncope by means of a tilt table experiment, during which 30 women were presented with disgusting pictures in a supine and a 70° upright position. The results showed that relative to disgust elicitation in the supine position, tilting reduced diastolic blood pressure during disgust elicitation, which could indicate increased risk for presyncope. Moreover, self-reported disgust proneness was positively correlated with heart rate during disgust induction in the tilted position. This association may point to a compensatory mechanism that aims at stabilizing mean arterial pressure. Disgust-prone individuals possibly utilized this mechanism more extensively to prevent fainting. Future investigations with a longer duration should follow up on this finding and compare the onset of presyncope between high and low disgust-prone individuals.

scholarly journals Evaluation and Management of Reflex Vasovagal Syncope—A Review

2021 ◽  
pp. 263246362110501
Author(s):  
Ameya Udyavar ◽  
Saurabh Deshpande
Keyword(s):  
Diagnostic Tests ◽  
Vasovagal Syncope ◽  
Ecg Monitoring ◽  
Single Test ◽  
Tilt Table ◽  
High Risk Factors ◽  
Cardiac Syncope ◽  
Tilt Table Testing ◽  
Electrocardiogram Ecg

Syncope is a symptom that is commonly encountered in the practice and may point to a cardiac or neurological diagnosis. The evaluation of syncope rests on a thorough clinical evaluation, aided by electrocardiogram (ECG) findings, followed by risk stratification of the particular case. Once high-risk factors have been ruled out, the patient can be further diagnosed as having a reflex syncope (RS), orthostatic hypotension, or cardiac syncope based on specific clues. If the initial evaluation is not confirmatory various diagnostic tests may be used to guide further management (eg, long-term ECG monitoring, tilt table testing, etc). The management should be based on the overall profile of the patient and not only on any single test. In this review, we discuss the evaluation of a patient with RS and give an overview of treatments available for the patients.

Sign in / Sign up

Export Citation Format

Share Document