Evaluation of edrophonium as a provocative agent for vasovagal syncope during head-up tilt-table testing

Lurie, Keith G.; Dutton, J.; Mangat, R.; Newman, David; Eisenberg, Susan J.; Scheinman, Melvin M.

doi:10.1016/0002-9149(93)90298-q

Cited by 43 publications

(6 citation statements)

References 21 publications

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“…92 Edrophonium, which inhibits acetylcholinesterase, significantly increases the identification of patients with vasovagal syncope, and may be particularly useful when provocation with isoproterenol is undesirable. 93 Acetylcholine, which is a potent stimulator of nitric oxide release, is increased during neurally-mediated syncope, which adds to vasodilatation. 66 The use of clomipramine, which blocks the reuptake of serotonin, can cause sympathetic withdrawal, and has been shown to improve the diagnostic value of the tilt table test.…”

Section: Evaluation and Diagnosismentioning

confidence: 99%

Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope

Medow¹,

Stewart²,

Sanyal³

et al. 2008

Cardiology in Review

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Orthostatic hypotension (OH) occurs in 0.5% of individuals and as many as 7-17% of patients in acute care settings. Moreover, OH may be more prevalent in the elderly due to the increased use of vasoactive medications and the concomitant decrease in physiologic function, such as baroreceptor sensitivity. OH may result in the genesis of a presyncopal state or result in syncope. OH is defined as a reduction of systolic blood pressure (SBP) of at least 20 mm Hg or diastolic blood pressure (DBP) of at least 10 mm Hg within 3 minutes of standing. A review of symptoms, and measurement of supine and standing BP with appropriate clinical tests should narrow the differential diagnosis and the cause of OH. The fall in BP seen in OH results from the inability of the autonomic nervous system (ANS) to achieve adequate venous return and appropriate vasoconstriction sufficient to maintain BP. An evaluation of patients with OH should consider hypovolemia, removal of offending medications, primary autonomic disorders, secondary autonomic disorders, and vasovagal syncope, the most common cause of syncope. Although further research is necessary to rectify the disease process responsible for OH, patients suffering from this disorder can effectively be treated with a combination of nonpharmacologic treatment, pharmacologic treatment, and patient education. Agents such as fludrocortisone, midodrine, and selective serotonin reuptake inhibitors have shown promising results. Treatment for recurrent vasovagal syncope includes increased salt and water intake and various drug treatments, most of which are still under investigation.

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Section: Evaluation and Diagnosismentioning

confidence: 99%

Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope

Medow¹,

Stewart²,

Sanyal³

et al. 2008

Cardiology in Review

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show abstract

“…Edrophonium,37 clomipramine,38 and adenosine 39–41 have all recently been reported as effective provocative agents in the tilt table aided diagnosis of vasovagal syncope, but further assessment of these agents is required before their more widespread adoption.…”

Section: Newcastle Protocols Overviewmentioning

confidence: 99%

The Newcastle protocols for head-up tilt table testing in the diagnosis of vasovagal syncope, carotid sinus hypersensitivity, and related disorders

Kenny

O’Shea

Parry

2000

Heart

128

121

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“…However, despite the widespread use of tilt testing, there is no agreement on a standard protocol. Various angles and durations of tilt are used, with or without provocative agents, including isoprenaline,1-4 edrophonium,5 and glyceryl trinitrate 6. Most early tilt studies used passive 60° tilt but this required up to 60 minutes of head up tilt to achieve satisfactory sensitivity 7-10.…”

mentioning

confidence: 99%

Haemodynamic effects of increasing angle of head up tilt

Zaidi

Benítez²,

Gaydecki³

et al. 2000

Heart

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Objective-To investigate the haemodynamic eVects of varying the angle of head up tilt. Methods-20 healthy subjects (12 female, eight male; mean (SD) age 33.6 (8.4) years) underwent head up tilt for five minutes to each of four angles of tilt in random order, with a five minute rest period at the horizontal between each angle. Forearm blood flow was measured using intermittent occlusion mercury strain gauge plethysmography at two and five minutes. Subjects underwent continuous monitoring of heart rate, systolic blood pressure (SBP), and diastolic blood pressure (DBP) by Finapres and cardiac output and stroke volume by impedance cardiography. Each variable was measured at two and five minutes, averaged over the period of blood flow measurement. Results-Every haemodynamic variable at each angle was significantly diVerent from supine values. Head up tilt produced progressive increases in heart rate (11-21%), SBP (12-21%), and DBP (20-33%) with increasing tilt angle. However, although 45°produced significantly less haemodynamic eVect, there were no significant diVerences for angles between 60°and 90°. Cardiac output fell on head up tilt by 17-20% and stroke volume by 28-34%, but increasing tilt angle produced no significant additional reduction in cardiac output and stroke volume because of increases in heart rate and vasoconstriction. Conclusions-Angles < 60°produce significantly less haemodynamic eVects than steeper angles. Increasing tilt angle beyond 60°produces no apparent additional eVect on cardiac output or sympathetic tone. Increasing tilt angle beyond 60°confers no additional orthostatic stress and may not aVect the sensitivity and specificity of head up tilt testing as previously thought. Sixty degrees of tilt is a more practical angle for support of a syncopal patient and is recommended.

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Evaluation of edrophonium as a provocative agent for vasovagal syncope during head-up tilt-table testing

Cited by 43 publications

References 21 publications

Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope

Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope

The Newcastle protocols for head-up tilt table testing in the diagnosis of vasovagal syncope, carotid sinus hypersensitivity, and related disorders

Haemodynamic effects of increasing angle of head up tilt

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