Europace

Europace 2002 4(3):333-338; doi:10.1053/eupc.2002.0241
© 2002 by European Society of Cardiology

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SYNCOPE

Haemodynamic changes early in prodromal symptoms of vasovagal syncope

P. Alboni¹, M. Dinelli¹, P. Gruppillo², M. Bondanelli³, K. Bettiol¹, P. Marchi² and E. C. degli Uberti³

¹Division of Cardiology, Ospedale Civile Cento (Fe), Italy; ²Division of Internal Medicine, Arcispedale S. Anna Ferrara, Italy; ³Section of Endocrinology, Department of Biomedical Sciences and Advanced Therapies, University of Ferrara Italy

Abstract

AIMS: Vasovagal syncope (VVS) is often preceded by prodromal symptoms. The haemodynamic changes occurring during the prodrome have not been systematically investigated. The aim of the present study was to investigate the behaviour of blood pressure (BP), heart rate (HR) and sympathetic activity at the beginning of the prodrome in patients with tilt-induced VVS.

METHODS AND RESULTS: Sixty-three patients with VVS underwent tilt testing. BP and HR were measured and blood samples for plasma catecholamine determination were obtained during the test.

Twenty-seven patients developed syncope of whom all had a prodrome. From the last scheduled measurement before prodromal symptoms to the beginning of the prodrome, both systolic and diastolic BP decreased in all patients (from 105±16 to 74±20 mmHg, P< 0·001, and from 68±13 to 51±12 mmHg, P< 0·001, respectively) and HR decreased in 18 (67%) (from 89±22 to 80±25 beats/min, P< 0·02). At the onset of loss of consciousness both BP and HR showed a further decrease (P< 0·001). Plasma adrenaline significantly increased from the last sample before prodromal symptoms to the beginning of the prodrome (P< 0·01) and showed a further increase during loss of consciousness (P< 0·05), whereas plasma noradrenaline did not increase, as an expression of inhibition of sympathetic neural outflow.

CONCLUSION: These results demonstrate that in patients with tilt-induced VVS, BP is consistently decreased at the beginning of prodromal symptoms because of the withdrawal of sympathetic activity, and HR is often reduced, probably because of increased vagal activity. We may infer that similar haemodynamic features also occur during spontaneous VVS. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Vasovagal syncope, tilt test, haemodynamics of syncope

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Correspondence: Dr Paolo Alboni, Division of Cardiology, Ospedale Civile, 44042 Cento (Fe), Italy. Tel.: 051/6838111; Fax: 051/6838471; E-mail: p.alboni{at}ausl.fe.it

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