The different clinical presentations of vasovagal syncope

Alboni, Paoló

doi:10.1136/heartjnl-2014-307096

Cited by 38 publications

(18 citation statements)

References 33 publications

(45 reference statements)

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“…In human medicine, after the introduction of the head-up tilt test in clinical practice, the clinical presentation of VVS has been classified as typical (or classical) and atypical (or non-classical) [102]. A few clinical features and recent data suggest that even unexplained falls and syncope during sleeping hours may possibly be clinical presentations of VVS.…”

Section: Disturbances Of the Autonomic Nervous Systemmentioning

confidence: 99%

“…These 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, diurnal episodes of typical VVS and specific phobias, and positive tilt testing with severe cardioinhibition [102].…”

Section: Disturbances Of the Autonomic Nervous Systemmentioning

confidence: 99%

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Indications for permanent pacing in dogs and cats

Santilli

Giacomazzi²,

Vázquez³

et al. 2019

Journal of Veterinary Cardiology

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Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome. ª

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Section: Disturbances Of the Autonomic Nervous Systemmentioning

confidence: 99%

Section: Disturbances Of the Autonomic Nervous Systemmentioning

confidence: 99%

Indications for permanent pacing in dogs and cats

Santilli

Giacomazzi²,

Vázquez³

et al. 2019

Journal of Veterinary Cardiology

View full text Add to dashboard Cite

show abstract

“…Syncope is defined as a transient loss of consciousness (TLoC), usually characterised by spontaneous, rapid, and complete recovery [1,2]. Clinical presentation of vasovagal syncope, the most common cause of neurally mediated TLoC, varies from typical (characterised by prodromal symptoms as nausea, vomiting, abdominal pain, pallor, sweating, and the presence of precipitating factors such as emotional distress or orthostatic stress) to atypical pattern (no evident trigger and no prodromal symptoms), or unexplained fall, or syncope during sleep [1].…”

Section: Introductionmentioning

confidence: 99%

Psychophysiological evaluation of patients with transient consciousness loss of uncertain origin

et al. 2018

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58% of patients with history of TLoC were PsyP+. In PsyP+ patients, DSM at rest correlates with higher prob-ability of NTG-induced syncope, which occurs with 60% increment of low frequency and 530% increment of VLF power. Conversely, in patients with prevalent vagal modulation at rest and a decrease in VLF power after NTG, syncope did not occur. This supports interpretation of VLF power as an index of stress-induced sympathetic activity.

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“…Increased adrenergic tone such as emotional stress or pain may trigger and contribute to VVS. Although VVS is frequently associated with more complex situations with various stressors and circumstances [1], increased adrenergic tone is thought to be the common trigger toward standing in general. Adrenergic surge after prolonged standing is believed to be a key initiating factor of tilt test using isoproterenol [2].…”

Section: Introductionmentioning

confidence: 99%

A new test for diagnosing vasovagal syncope: Standing after treadmill test with sublingual nitrate administration

Kim

Jang

Kim³

et al. 2017

PLoS ONE

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IntroductionIncreased adrenergic tone might be an additional trigger of orthostatic stress of vasovagal syncope (VVS). Exercise before standing might provide increased sensitivity compared to standing using a sublingual nitroglycerines protocol during tilt table testing. The aim of this study was to evaluate the diagnostic value of treadmill testing before standing with nitroglycerin administration.Methods and resultsA total of 36 patients with syncope or presyncope were enrolled for the test. VVS was confirmed in 29 patients according to the Calgary Score (≥ -2), including 20 patients who were likely to have typical (classical) VVS. All 36 subjects were subjected to a novel provocation test consisting of treadmill test using the Bruce protocol followed by standing with administration of 300 μg sublingual nitroglycerin. Consequently, syncope or presyncope occurred in 22 patients of the 36 patients. The sensitivity and a specificity of the test for Calgary score based VVS was 82.7% and 85.75%, respectively. Reproducibility rate for typical VVS was 90% (18 of 20). In all symptomatic patients, systolic blood pressure dropped to < 90 mmHg and symptom occurred a mean of 6.7 ± 2.3 minutes after the nitroglycerine administration. No patient required anticholinergics injection to restore vital signs.ConclusionsTreadmill test with administration of sublingual nitroglycerines might be safely used to reproduce syncope in patients with VVS. More clinical experience and confirmation are needed to validate this protocol.

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The different clinical presentations of vasovagal syncope

Cited by 38 publications

References 33 publications

Indications for permanent pacing in dogs and cats

Indications for permanent pacing in dogs and cats

Psychophysiological evaluation of patients with transient consciousness loss of uncertain origin

A new test for diagnosing vasovagal syncope: Standing after treadmill test with sublingual nitrate administration

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