Are syncopes in sitting and supine positions different? Body positions and syncope: A study of 111 patients

Khadilkar, Satish V; Yadav, Rakhil S.; Jagiasi, Kamlesh

doi:10.4103/0028-3886.115060

Cited by 13 publications

(33 citation statements)

References 9 publications

(16 reference statements)

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“…In studies dealing with typical VVS, syncope occurring in the horizontal position was observed in only 5% of subjects and was always triggered by emotional distress 3 29. When syncope occurs in the supine position, a cardiac cause of syncope should first be considered; if a cardiac cause is excluded, other examinations, chosen on the basis of the clinical presentation, should be performed.…”

Section: Syncope During Sleeping Hoursmentioning

confidence: 99%

“…The possible underlying mechanisms include the circadian-modulated increase in parasympathetic nervous activity, decreased sympathetic nervous system activity, decreased systolic blood pressure and decreased cardiac output during the night. As some subjects have reported nightmares immediately before sleep syncope,29 some episodes might actually be emotional VVS. Sleep syncope can be diagnosed in the presence of typical autonomic prodromes and in the absence of structural heart disease or primary electrical disease.…”

Section: Syncope During Sleeping Hoursmentioning

confidence: 99%

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The different clinical presentations of vasovagal syncope

Alboni¹

2015

Heart

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For some decades, after the introduction of the head-up tilt test into clinical practice, the clinical presentation of vasovagal syncope (VVS) has been classified as typical (or classical) and atypical (or non-classical). Some clinical features and recent data suggest that even unexplained falls and syncope during sleeping hours may be possible clinical presentations of VVS. In recent studies, tilt testing and carotid sinus massage by means of the 'method of symptoms' were performed in one group of patients with unexplained falls and in another group with unexplained syncope (presence of prodromal symptoms). Overall, tilt testing and carotid sinus massage displayed a high positivity rate in the group of patients with unexplained falls (about 60%), which was similar to that of the unexplained syncope group. These new data seem to indicate that some unexplained falls could be cases of atypical VVS/carotid sinus syncope with retrograde amnesia. Some clinical features suggest that syncope during sleeping hours is a form of VVS with a different clinical presentation: high prevalence of autonomic prodromes, of diurnal episodes of typical VVS and specific phobias, and of positive tilt testing with severe cardioinhibition.

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Section: Syncope During Sleeping Hoursmentioning

confidence: 99%

Section: Syncope During Sleeping Hoursmentioning

confidence: 99%

The different clinical presentations of vasovagal syncope

Alboni¹

2015

Heart

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“…Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion with recovery being spontaneous and instantaneous [1-2]. It is a common ailment that forms 3% of emergency admissions and 1% of general hospital admissions [3].…”

Section: Introductionmentioning

confidence: 99%

“…However, recent literature now supports the hypothesis that both vagally mediated hypotension and cardioinhibition can be noted while in a supine position. Several reports of supine loss of consciousness, which was determined to be vagal in mechanism, have been reported in the literature [1,11-13], and in 2006, a study named this phenomenon “sleep syncope” or “sleep fainting” and suggested it as a new clinical entity [14]. Furthermore, this phenomenon is not an uncommon observation in hospital settings in which the patient is supine, such as while venepuncture is performed and vagal symptoms are noted [15].…”

Section: Introductionmentioning

confidence: 99%

Sleep Fainting: A Neurocardiogenic Entity

Shahab¹,

Sonawalla²,

Khan³

et al. 2018

Cureus

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Fainting is a common clinical presentation, with vagally mediated (neurocardiogenic) causes being the most common for syncope presentation to the emergency room, and for hospital admissions. Classic teaching is that upright posture is a prerequisite for vagally mediated syncope (VMS) and that syncope in the supine position has more sinister causes. We present five patients, three males and two females, with a mean age of 44.4 (range 29–67) years, who presented with VMS in the supine position (sleep fainting). Four patients also had a history of classic upright syncope. Based on their clinical features and thorough investigations, we excluded other causes of loss of consciousness and diagnosed these patients to be having VMS in the supine position (sleep fainting). We further describe the management and follow-up of these patients. Sleep fainting/syncope is a new entity and has to be recognized for appropriate management. A diagnosis can be established if there is clinical suspicion, preserved left ventricular function without evidence of coronary artery disease, no high-risk electrocardiographic evidence of pre-excitation, long or short QT syndrome, Brugada syndrome or arrhythmogenic right ventricular dysplasia, and normal neurological work-up.

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“…The clinical clue is that sitting intolerance symptoms were observed in clinical practice, such as dizziness, palpitations, chest tightness, etc. elicited by sitting and relieved by recumbence 8,9 . Therefore, in children and adolescents, abnormal changes in heart rate and blood pressure might sometimes occur during sitting or the postural change from supine to sitting and be ambiguously associated with sitting intolerance which means that subjects are disturbed by the abovementioned symptoms during sitting or changing from supine to sitting.…”

mentioning

confidence: 99%

Sitting-induced hemodynamic changes and association with sitting intolerance in children and adolescents: a cross-sectional study

Tao

Han

Yan

et al. 2020

Sci Rep

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Hemodynamic alteration with postural change from supine to sitting has been unclear in the young. In the cross-sectional study, 686 participants (371 boys and 315 girls, aged 6-18 years) were recruited from 4 schools in Kaifeng city, the central area of China. The active sitting test was performed to obtain heart rate (HR) and blood pressure (BP) changes from supine to sitting in children and adolescents. Hemodynamic change-associated sitting intolerance was analyzed. In the study participants, the 95th percentile (P 95) values of changes in HR and BP within 3 min from supine to sitting were 25 beats/min and 18/19 mm Hg, respectively. Sixty-six participants had sitting intolerance symptoms. Compared with participants without sitting intolerance symptoms, those with symptoms more frequently had HR increase ≥ P 95 or BP increase ≥ P 95 within 3 min from supine to sitting (P < 0.001). Risk factors for sitting intolerance were age (odds ratio 1.218, 95% confidence interval 1.072-1.384, P = 0.002) and changes in HR or BP ≥ P 95 within 3 min after sitting (odds ratio 2.902, 95% confidence interval 1.572-5.357, P = 0.001). We firstly showed hemodynamic changing profiles from supine to sitting and their association with sitting intolerance in children and adolescents. Sitting tachycardia is likely suggested with a change in HR ≥ 25 beats/min and sitting hypertension with a change in BP ≥ 20/20 mm Hg when changing from supine to sitting within 3 min. The age and changes in HR or BP were independent risk factors for sitting intolerance. Lying, sitting and standing are inevitable postures in daily life, and blood distribution changes are accompanied by postural changes. Physiologically, changing from the supine to the orthostatic position induces an instantaneous and large shift of 10% to 25% of blood volume from the thorax to the lower extremities and splanchnic organs and a transfer from the vasculature to the interstitial tissues. This redistribution causes an immediate decrease in venous return to the heart, resulting in a transient decline in cardiac filling and blood pressure. Then, positive chronotropic and inotropic cardiac effects are stimulated by activation of the sympathetic nervous system and withdrawal of the parasympathetic nervous system to maintain a relatively stable circulatory condition,

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Are syncopes in sitting and supine positions different? Body positions and syncope: A study of 111 patients

Cited by 13 publications

References 9 publications

The different clinical presentations of vasovagal syncope

The different clinical presentations of vasovagal syncope

Sleep Fainting: A Neurocardiogenic Entity

Sitting-induced hemodynamic changes and association with sitting intolerance in children and adolescents: a cross-sectional study

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