Role of endogenous opioids in syncope induced by head-up tilt test and its relationship with isoproterenol-dependent and isoproterenol-independent neurally-mediated syncope

Pérez‐Paredes, Matías; Picó-Aracil, Francisco; Fuentes-Jiménez, Teo; Sánchez-Villanueva, José G; Expósito-Ordoñez, Elena; Gonzálvez-Ortega, Manuel; González-Caballero, Eva; Nicolás-Garcia, F; Rosa, José Antônio; Ruiz-Ros, José A.; Ruipérez-Abizanda, Juan A.

doi:10.1016/s0167-5273(98)00220-4

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…In the present study, the decrease in systolic blood pressure levels during tilt-induced syncope were identical among the three groups. Since the plasma β-endorphin levels were not reported to increase despite tilt-induced hypotension during an isoproterenol provocation tilt test, 6) which correlates with our findings obtained in group 4 in this study, it is unlikely that hypotension and syncope resulted due to a rise in the β-endorphin level. However, further investigation is needed to clarify this question.…”

Section: Discussionsupporting

confidence: 90%

“…However, naloxone, which is a selective β-endorphin inhibitor, could not prevent tilt-induced syncope. 6) These results thus suggest that β-endorphin is not a causative substance. In the present study, the decrease in systolic blood pressure levels during tilt-induced syncope were identical among the three groups.…”

Section: Discussionmentioning

confidence: 83%

“…However, most of these studies were conducted during a head-up tilt test without pharmacological provocation. [8][9][10] Perez-Paredes, et al 6) measured the plasma levels of β-endorphin during an isoproterenol provocation tilt test and found no increase in plasma β-endorphin levels at the time of isoproterenol-induced syncope during a head-up tilt test. This previous observation correlated with our results.…”

Section: Discussionmentioning

confidence: 99%

“…6) However, so far few reports have studied the effect of a nitroglycerin provocation test on the plasma levels of β-endorphin and epinephrine.…”

mentioning

confidence: 99%

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Endogenous Opioids and Epinephrine in Nitroglycerin Provocation Tilt Test in Patients with Neurally Mediated Syncope

et al. 2003

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SUMMARYEndogenous opioids and catecholamines are involved in autonomic activity. Nitroglycerin provocation tilt is a useful modality for evaluating neurally mediated syncope. Endogenous opioids and epinephrine might play an important role in nitroglycerin provocation tilt. To investigate whether or not opioids and catecholamines are involved in the pathogenesis of nitroglycerin provocation tilt, we measured the temporal changes of the plasma levels of β endorphin, norepinephrine, and epinephrine in 64 patients with syncope of unknown etiology, and compared the findings with those of 16 patients who underwent isoproterenol provocation tilt (1-3 µg/min) test with a positive response. We performed a 20 minute control tilt (80°) followed by a nitroglycerin provocation tilt of 20 minutes with the intravenous infusion of nitroglycerin. Nitroglycerin infusion was started at 250 µg/h, and was increased by 250 µg/h every 3 minutes up to 1500 µg/h during the tilt test. β-endorphin, norepinephrine, and epinephrine were measured in peripheral venous blood in the supine position 2, 10, and 20 minutes after the start of the tilt test, and also at the onset of syncope. Twenty-six patients had a positive response to the control tilt (group 1), and 22 patients had a positive response to nitroglycerin provocation tilt (group 2). The remaining 16 patients had a negative response to both control tilt and nitroglycerin provocation tilt (group 3), compared with isoproterenol provocation tilt patients (group 4). β-endorphin and epinephrine only significantly increased in groups 1 and 2 (β-endorphin; from 7.3 ± 3.3 pg/mL to 19.9 ± 17.7 pg/mL, in group 1, P < 0.05; from 7.3 ± 2.9 to 16.5 ± 10.7 pg/mL, in group 2, P < 0.05: epinephrine; from 42 ± 58 pg/mL to 157 ± 161 pg/ mL, in group 1, P < 0.05; from 33 ± 25 to 202 ± 252 pg/mL, in group 2, P < 0.05), but not in groups 3 and 4. β-endorphin and epinephrine might participate in the pathophysiology in conventional tilt-induced as well as nitroglycerin provocation tilt-induced syncope in patients with neurally mediated syncope. (Jpn Heart J 2003; 44: 493-503) 2,3) These findings suggest that either β-endorphin or epinephrine plays a significant role in the pathogenesis of neurally-mediated syncope. Nitroglycerin provocation tilt is a useful modality for diagnosing neurallymediated syncope.4) In addition, isoproterenol infusion during the head-up tilt test has been proposed to be a useful adjunctive method with which to induce neurally mediated syncope in patients with syncope of unknown etiology. 5) Although both provocation tests have been utilized, the mechanism of the nitroglycerin provocation test might be different from that of the isoproterenol test.In the isoproterenol provocation test, an earlier report revealed that the increase in the plasma levels of β-endorphin or epinephrine was relatively small, compared with that of the head-up tilt test without provocations. 6) However, so far few reports have studied the effect of a nitroglycerin provocation test on the plasma levels of...

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

“…6) However, so far few reports have studied the effect of a nitroglycerin provocation test on the plasma levels of β-endorphin and epinephrine.…”

mentioning

confidence: 99%

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Endogenous Opioids and Epinephrine in Nitroglycerin Provocation Tilt Test in Patients with Neurally Mediated Syncope

et al. 2003

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“…Studies on animals and humans showed that endogenous opioids affect sympathetic responses in orthostatic stress by inhibiting their tonic effect, thus inducing syncope. 11,12 Moreover, it was shown that the blockade of opioid receptors modulates sympathetic response and restores glucose production in healthy adults, thus preventing the syndrome of hypoglycemiainduced autonomic failure 13 and exercise-associated autonomic failure. 14 This may suggest that prolonged abuse of high doses of codeine may cause overstimulation of opioid receptors, leading to failure in autonomic neural regulation.…”

Section: Codeine-induced Sensory Neuropathy Autonomic Dysfunction Amentioning

confidence: 99%

Codeine‐Induced Sensory Neuropathy, Autonomic Dysfunction, and Myopathy

Malek

Salameh

2018

The Journal of Clinical Pharma

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Endogenous opiates: 1998☆

Vaccarino

Olson

et al. 1999

Peptides

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Role of endogenous opioids in syncope induced by head-up tilt test and its relationship with isoproterenol-dependent and isoproterenol-independent neurally-mediated syncope

Cited by 7 publications

References 24 publications

Endogenous Opioids and Epinephrine in Nitroglycerin Provocation Tilt Test in Patients with Neurally Mediated Syncope

Endogenous Opioids and Epinephrine in Nitroglycerin Provocation Tilt Test in Patients with Neurally Mediated Syncope

Codeine‐Induced Sensory Neuropathy, Autonomic Dysfunction, and Myopathy

Endogenous opiates: 1998☆

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