Neurally Mediated Syncope

Overview

Journal Tex Heart Inst J

Specialty Cardiology & Vascular Diseases

Date 2000 Nov 28

PMID 11093411

Citations 13

Authors

M Zaqqa

A Massumi

Affiliations

Soon will be listed here.

Abstract

Neurally mediated syncope is a disorder of the autonomic regulation of postural tone, which results in hypotension, bradycardia, and loss of consciousness. A wide variety of stimuli can trigger this reflex, the most common stimulus being orthostatic stress. Typically, a patient with neurally mediated syncope experiences nausea, lightheadedness, a feeling of warmth, and pallor before abruptly losing consciousness. If the cause of syncope is unclear, a stepwise approach is necessary to arrive at the diagnosis. The diagnosis of neurally mediated syncope can be confirmed by a head-up tilt-table test. Treatment options include behavioral modification and several pharmacologic therapies. For severe recurrent syncope unresponsive to conventional treatment, a pacemaker can be implanted.

Citing Articles

Association of adenylate cyclase activity in vasopressor-type neurally mediated syncope based on the α2b-AR gene.

Komiyama T, Ayabe K, Orita K, Sasaki A, Kitamura Y, Matsuzawa H PLoS One. 2025; 20(2):e0317817.

PMID: 39899602 PMC: 11790091. DOI: 10.1371/journal.pone.0317817.

PR Interval as a Valuable Predictor of Tilt Table Test Results in Patients With Neurally Mediated Syncope.

Nikoo M, Narimani-Javid R, Kamrava A, Shafiei S, Nozhat S, Fatemian H Ann Noninvasive Electrocardiol. 2025; 30(2):e70054.

PMID: 39887894 PMC: 11783229. DOI: 10.1111/anec.70054.

Identical anatomy, different symptoms: a comparative case study of median arcuate ligament syndrome in monozygotic twins.

Anthony L, Gillies M, Bayat I BMJ Case Rep. 2024; 17(3).

PMID: 38471709 PMC: 10936490. DOI: 10.1136/bcr-2024-259684.

Heart Rate Variability in Unexplained Syncope Patients Versus Healthy Controls: A Comparative Study.

Dash R, Samanta P, Das S, Jena A, Panda B, Parida B Cureus. 2023; 15(7):e41370.

PMID: 37546077 PMC: 10399967. DOI: 10.7759/cureus.41370.

Neurally Mediated Syncope Triggered by COVID-19 Nasopharyngeal Swab Specimen Collection: A Case Report.

Bloom W, Bloom T Allergy Rhinol (Providence). 2022; 13:21526567211073794.

PMID: 35096463 PMC: 8796065. DOI: 10.1177/21526567211073794.

References

Di Girolamo E, Di Iorio C, Leonzio L, Sabatini P, Barsotti A . Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: A controlled study. Circulation. 1999; 100(17):1798-801. DOI: 10.1161/01.cir.100.17.1798. View

SHY G, DRAGER G . A neurological syndrome associated with orthostatic hypotension: a clinical-pathologic study. Arch Neurol. 1960; 2:511-27. DOI: 10.1001/archneur.1960.03840110025004. View

Bloomfield D, Sheldon R, Grubb B, Calkins H, Sutton R . Putting it together: a new treatment algorithm for vasovagal syncope and related disorders. Am J Cardiol. 1999; 84(8A):33Q-39Q. DOI: 10.1016/s0002-9149(99)00694-3. View

Leonelli F, Wang K, Evans J, Patwardhan A, Ziegler M, Natale A . False positive head-up tilt: hemodynamic and neurohumoral profile. J Am Coll Cardiol. 2000; 35(1):188-93. DOI: 10.1016/s0735-1097(99)00500-8. View

Parry S, Kenny R . Tilt table testing in the diagnosis of unexplained syncope. QJM. 1999; 92(11):623-9. DOI: 10.1093/qjmed/92.11.623. View

Baum T, Shropshire A . Inhibition of efferent sympathetic nerve activity by 5-hydroxytryptophan and centrally administered 5-hydroxytryptamine. Neuropharmacology. 1975; 14(3):227-33. DOI: 10.1016/0028-3908(75)90010-6. View

Mark A . The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983; 1(1):90-102. DOI: 10.1016/s0735-1097(83)80014-x. View

Sra J, Anderson A, Sheikh S, Avitall B, Tchou P, Troup P . Unexplained syncope evaluated by electrophysiologic studies and head-up tilt testing. Ann Intern Med. 1991; 114(12):1013-9. DOI: 10.7326/0003-4819-114-12-1013. View

Brignole M, Menozzi C, LOLLI G, Bottoni N, Gaggioli G . Long-term outcome of paced and nonpaced patients with severe carotid sinus syndrome. Am J Cardiol. 1992; 69(12):1039-43. DOI: 10.1016/0002-9149(92)90860-2. View

10.

Kapoor W . Evaluation and management of the patient with syncope. JAMA. 1992; 268(18):2553-60. View

11.

Muller G, Deal B, Strasburger J, Benson Jr D . Usefulness of metoprolol for unexplained syncope and positive response to tilt testing in young persons. Am J Cardiol. 1993; 71(7):592-5. DOI: 10.1016/0002-9149(93)90517-g. View

12.

Grubb B, Wolfe D, Samoil D, Hahn H, Elliott L . Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced syncope. Pacing Clin Electrophysiol. 1993; 16(3 Pt 1):458-64. DOI: 10.1111/j.1540-8159.1993.tb01608.x. View

13.

Fitzpatrick A, Banner N, Cheng A, Yacoub M, Sutton R . Vasovagal reactions may occur after orthotopic heart transplantation. J Am Coll Cardiol. 1993; 21(5):1132-7. DOI: 10.1016/0735-1097(93)90235-s. View

14.

JACOBSEN T, Morgan B, Scherrer U, Vissing S, Lange R, Johnson N . Relative contributions of cardiopulmonary and sinoaortic baroreflexes in causing sympathetic activation in the human skeletal muscle circulation during orthostatic stress. Circ Res. 1993; 73(2):367-78. DOI: 10.1161/01.res.73.2.367. View

15.

Mion Jr D, Rea R, Anderson E, Kahn D, Sinkey C, Mark A . Effects of fludrocortisone on sympathetic nerve activity in humans. Hypertension. 1994; 23(1):123-30. DOI: 10.1161/01.hyp.23.1.123. View

16.

Grubb B, Samoil D, Kosinski D, Kip K, BREWSTER P . Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol. 1994; 24(2):490-4. DOI: 10.1016/0735-1097(94)90308-5. View

17.

Dhala A, Natale A, Sra J, Deshpande S, Blanck Z, Jazayeri M . Relevance of asystole during head-up tilt testing. Am J Cardiol. 1995; 75(4):251-4. DOI: 10.1016/0002-9149(95)80030-v. View

18.

Furlan R, Piazza S, Bevilacqua M, Turiel M, Norbiato G, Lombardi F . Pure Autonomic Failure: complex abnormalities in the neural mechanisms regulating the cardiovascular system. J Auton Nerv Syst. 1995; 51(3):223-35. DOI: 10.1016/0165-1838(94)00135-7. View

19.

Scott W, Pongiglione G, BROMBERG B, Schaffer M, Deal B, Fish F . Randomized comparison of atenolol and fludrocortisone acetate in the treatment of pediatric neurally mediated syncope. Am J Cardiol. 1995; 76(5):400-2. DOI: 10.1016/s0002-9149(99)80110-6. View

20.

Cox M, Perlman B, Mayor M, Silberstein T, Levin E, Pringle L . Acute and long-term beta-adrenergic blockade for patients with neurocardiogenic syncope. J Am Coll Cardiol. 1995; 26(5):1293-8. DOI: 10.1016/0735-1097(95)00320-7. View