Neurally mediated syncope

Pathogenesis, diagnosis, and treatment

Horacio Kaufmann, D. D. Savage, L. Corwin, D. L. McGee, Howard Eliot Gendelman, M. Linzer, M. Gabelman, S. C. Day, E. F. Cook, H. Funkenstein, T. Lewis, M. G. Ziegler, C. R. Lake, I. J. Kopin, R. Bannister, P. Sever, M. Gross, E. Oribe, H. Kaufmann, S. Winters & 183 others J. F. Sneddon, P. J. Counihan, Y. Bashir, H. Boudoulas, A. M. Weissler, R. P. Lewis, S. Weiss, J. P. Baker, T. C. Dehn, C. A. Morley, R. Sutton, C. J. Mathias, E. Armstrong, N. Browse, E. C. Shaw, H. H. Young, W. N. Kapoor, J. R. Peterson, M. Karpf, E. D. Palmer, A. L. Mark, F. M. Abboud, B. Oberg, P. Thoren, P. Thoren, J. O. Skarphedinsson, S. Carlsson, A. Jarisch, Y. Zotterman, Y. Shalev, R. Gal, P. J. Tchou, E. Oribe, H. Kaufmann, U. Scherrer, S. Vissing, B. J. Morgan, A. P. Fitzpatrick, N. Bannder, A. Cheng, T. D. Maloney, F. J. Jaeger, F. M. Fouad-Tarazi, S. Milstein, J. Buetikofer, J. Lesser, J. S. Sra, M. R. Jazayeri, B. Avitall, H. Barcroft, O. G. Edholm, H. Barcroft, J. McMichael, E. P. Sharpey-Shafer, S. E. Epstein, M. Stampfer, D. Beiser, R. H. Murray, L. J. Thompson, J. A. Bowers, B. G. Wallin, G. Sundlof, B. G. Wallin, C. E. Westerberg, G. Sundloff, D. Burke, G. Sundloff, G. Wallin, H. Kaufmann, E. Oribe, J. A. Oliver, H. Kaufmann, E. Oribe, M. Miller, W. E. Glover, A. D.M. Greenfield, R. G. Shanks, B. J. Robinson, R. H. Johnson, D. Robertson, G. A. Johnson, R. M. Robertson, R. M. Palmer, D. S. Ashton, S. Moncada, S. Moncada, R. M. Palmer, E. A. Higgs, V. Bolotina, S. Najibi, J. Palacino, J. Tolins, R. M.J. Palmer, S. Moncada, H. Kaufmann, J. Berman, E. Oribe, R. A. Kenny, A. Ingram, J. Bayliss, A. Fitzpatrick, R. Sutton, F. Abi-Samra, J. D. Maloney, F. Fouad-Tarazi, A. Almquist, I. F. Goldenberg, S. Milstein, H. Kaufmann, E. Oribe, S. Winters, B. Strasberg, E. Rechavia, A. Sagie, A. Raviele, G. Gasparini, F. Di Pede, B. P. Grubb, P. Temsey-Armos, H. Hahn, M. Brignole, C. Menozzi, L. Gianfranchi, J. S. Sra, A. J. Anderson, S. H. Sheik, R. Sheldon, S. Killam, M. B. Waxman, L. Yao, D. A. Cameron, W. N. Kapoor, N. Brant, A. Raviele, G. Gasparini, F. Di Pede, G. Micieli, A. Cavallini, C. Tasorelli, K. M. El-Bedawi, R. Hainsworth, E. Oribe, H. Kaufmann, S. Winters, I. B. Davies, R. Bannister, P. S. Sever, S. Balaji, P. C. Oslizlok, M. C. Allen, D. Dacosta, S. McIntosh, R. A. Kenny, M. D. Thames, F. M. Abi Samra, N. M. Davison, R. D. Gardner, A. S. O'marcaigh, S. G. MacLellan-Tobert, C. J. Porter, M. I. Dangovian, R. Jarandilla, H. Frumin, S. Milstein, J. Buetikofer, J. Lesser, C. A. Morillo, J. W. Leitch, R. Yee, C. J. McLaran, B. J. Gersh, M. J. Osborn, S. Nelson, M. Stanley, C. Love, A. Susmano, A. S. Volgman, T. A. Buckingham, M. J. Strieper, R. Campbell, B. P. Grubb, D. Wolfe, D. Samoil

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.

Original languageEnglish (US)
Pages (from-to)S12-S18
JournalNeurology
Volume45
Issue number4
StatePublished - Jan 1 1995

Fingerprint

Syncope
Vasodilation
Hypotension
Therapeutics
Nitric Oxide
Mechanoreceptors
Viscera
Endothelin-1
Bradycardia
Vasopressins
Vasodilator Agents
Angiotensin II
Epinephrine
Heart Ventricles
Reflex
Heart Diseases
Norepinephrine
Sensitivity and Specificity

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Kaufmann, H., Savage, D. D., Corwin, L., McGee, D. L., Gendelman, H. E., Linzer, M., ... Samoil, D. (1995). Neurally mediated syncope: Pathogenesis, diagnosis, and treatment. Neurology, 45(4), S12-S18.

Neurally mediated syncope : Pathogenesis, diagnosis, and treatment. / Kaufmann, Horacio; Savage, D. D.; Corwin, L.; McGee, D. L.; Gendelman, Howard Eliot; Linzer, M.; Gabelman, M.; Day, S. C.; Cook, E. F.; Funkenstein, H.; Lewis, T.; Ziegler, M. G.; Lake, C. R.; Kopin, I. J.; Bannister, R.; Sever, P.; Gross, M.; Oribe, E.; Kaufmann, H.; Winters, S.; Sneddon, J. F.; Counihan, P. J.; Bashir, Y.; Boudoulas, H.; Weissler, A. M.; Lewis, R. P.; Weiss, S.; Baker, J. P.; Dehn, T. C.; Morley, C. A.; Sutton, R.; Mathias, C. J.; Armstrong, E.; Browse, N.; Shaw, E. C.; Young, H. H.; Kapoor, W. N.; Peterson, J. R.; Karpf, M.; Palmer, E. D.; Mark, A. L.; Abboud, F. M.; Oberg, B.; Thoren, P.; Thoren, P.; Skarphedinsson, J. O.; Carlsson, S.; Jarisch, A.; Zotterman, Y.; Shalev, Y.; Gal, R.; Tchou, P. J.; Oribe, E.; Kaufmann, H.; Scherrer, U.; Vissing, S.; Morgan, B. J.; Fitzpatrick, A. P.; Bannder, N.; Cheng, A.; Maloney, T. D.; Jaeger, F. J.; Fouad-Tarazi, F. M.; Milstein, S.; Buetikofer, J.; Lesser, J.; Sra, J. S.; Jazayeri, M. R.; Avitall, B.; Barcroft, H.; Edholm, O. G.; Barcroft, H.; McMichael, J.; Sharpey-Shafer, E. P.; Epstein, S. E.; Stampfer, M.; Beiser, D.; Murray, R. H.; Thompson, L. J.; Bowers, J. A.; Wallin, B. G.; Sundlof, G.; Wallin, B. G.; Westerberg, C. E.; Sundloff, G.; Burke, D.; Sundloff, G.; Wallin, G.; Kaufmann, H.; Oribe, E.; Oliver, J. A.; Kaufmann, H.; Oribe, E.; Miller, M.; Glover, W. E.; Greenfield, A. D.M.; Shanks, R. G.; Robinson, B. J.; Johnson, R. H.; Robertson, D.; Johnson, G. A.; Robertson, R. M.; Palmer, R. M.; Ashton, D. S.; Moncada, S.; Moncada, S.; Palmer, R. M.; Higgs, E. A.; Bolotina, V.; Najibi, S.; Palacino, J.; Tolins, J.; Palmer, R. M.J.; Moncada, S.; Kaufmann, H.; Berman, J.; Oribe, E.; Kenny, R. A.; Ingram, A.; Bayliss, J.; Fitzpatrick, A.; Sutton, R.; Abi-Samra, F.; Maloney, J. D.; Fouad-Tarazi, F.; Almquist, A.; Goldenberg, I. F.; Milstein, S.; Kaufmann, H.; Oribe, E.; Winters, S.; Strasberg, B.; Rechavia, E.; Sagie, A.; Raviele, A.; Gasparini, G.; Di Pede, F.; Grubb, B. P.; Temsey-Armos, P.; Hahn, H.; Brignole, M.; Menozzi, C.; Gianfranchi, L.; Sra, J. S.; Anderson, A. J.; Sheik, S. H.; Sheldon, R.; Killam, S.; Waxman, M. B.; Yao, L.; Cameron, D. A.; Kapoor, W. N.; Brant, N.; Raviele, A.; Gasparini, G.; Di Pede, F.; Micieli, G.; Cavallini, A.; Tasorelli, C.; El-Bedawi, K. M.; Hainsworth, R.; Oribe, E.; Kaufmann, H.; Winters, S.; Davies, I. B.; Bannister, R.; Sever, P. S.; Balaji, S.; Oslizlok, P. C.; Allen, M. C.; Dacosta, D.; McIntosh, S.; Kenny, R. A.; Thames, M. D.; Abi Samra, F. M.; Davison, N. M.; Gardner, R. D.; O'marcaigh, A. S.; MacLellan-Tobert, S. G.; Porter, C. J.; Dangovian, M. I.; Jarandilla, R.; Frumin, H.; Milstein, S.; Buetikofer, J.; Lesser, J.; Morillo, C. A.; Leitch, J. W.; Yee, R.; McLaran, C. J.; Gersh, B. J.; Osborn, M. J.; Nelson, S.; Stanley, M.; Love, C.; Susmano, A.; Volgman, A. S.; Buckingham, T. A.; Strieper, M. J.; Campbell, R.; Grubb, B. P.; Wolfe, D.; Samoil, D.

In: Neurology, Vol. 45, No. 4, 01.01.1995, p. S12-S18.

Research output: Contribution to journalArticle

Kaufmann, H, Savage, DD, Corwin, L, McGee, DL, Gendelman, HE, Linzer, M, Gabelman, M, Day, SC, Cook, EF, Funkenstein, H, Lewis, T, Ziegler, MG, Lake, CR, Kopin, IJ, Bannister, R, Sever, P, Gross, M, Oribe, E, Kaufmann, H, Winters, S, Sneddon, JF, Counihan, PJ, Bashir, Y, Boudoulas, H, Weissler, AM, Lewis, RP, Weiss, S, Baker, JP, Dehn, TC, Morley, CA, Sutton, R, Mathias, CJ, Armstrong, E, Browse, N, Shaw, EC, Young, HH, Kapoor, WN, Peterson, JR, Karpf, M, Palmer, ED, Mark, AL, Abboud, FM, Oberg, B, Thoren, P, Thoren, P, Skarphedinsson, JO, Carlsson, S, Jarisch, A, Zotterman, Y, Shalev, Y, Gal, R, Tchou, PJ, Oribe, E, Kaufmann, H, Scherrer, U, Vissing, S, Morgan, BJ, Fitzpatrick, AP, Bannder, N, Cheng, A, Maloney, TD, Jaeger, FJ, Fouad-Tarazi, FM, Milstein, S, Buetikofer, J, Lesser, J, Sra, JS, Jazayeri, MR, Avitall, B, Barcroft, H, Edholm, OG, Barcroft, H, McMichael, J, Sharpey-Shafer, EP, Epstein, SE, Stampfer, M, Beiser, D, Murray, RH, Thompson, LJ, Bowers, JA, Wallin, BG, Sundlof, G, Wallin, BG, Westerberg, CE, Sundloff, G, Burke, D, Sundloff, G, Wallin, G, Kaufmann, H, Oribe, E, Oliver, JA, Kaufmann, H, Oribe, E, Miller, M, Glover, WE, Greenfield, ADM, Shanks, RG, Robinson, BJ, Johnson, RH, Robertson, D, Johnson, GA, Robertson, RM, Palmer, RM, Ashton, DS, Moncada, S, Moncada, S, Palmer, RM, Higgs, EA, Bolotina, V, Najibi, S, Palacino, J, Tolins, J, Palmer, RMJ, Moncada, S, Kaufmann, H, Berman, J, Oribe, E, Kenny, RA, Ingram, A, Bayliss, J, Fitzpatrick, A, Sutton, R, Abi-Samra, F, Maloney, JD, Fouad-Tarazi, F, Almquist, A, Goldenberg, IF, Milstein, S, Kaufmann, H, Oribe, E, Winters, S, Strasberg, B, Rechavia, E, Sagie, A, Raviele, A, Gasparini, G, Di Pede, F, Grubb, BP, Temsey-Armos, P, Hahn, H, Brignole, M, Menozzi, C, Gianfranchi, L, Sra, JS, Anderson, AJ, Sheik, SH, Sheldon, R, Killam, S, Waxman, MB, Yao, L, Cameron, DA, Kapoor, WN, Brant, N, Raviele, A, Gasparini, G, Di Pede, F, Micieli, G, Cavallini, A, Tasorelli, C, El-Bedawi, KM, Hainsworth, R, Oribe, E, Kaufmann, H, Winters, S, Davies, IB, Bannister, R, Sever, PS, Balaji, S, Oslizlok, PC, Allen, MC, Dacosta, D, McIntosh, S, Kenny, RA, Thames, MD, Abi Samra, FM, Davison, NM, Gardner, RD, O'marcaigh, AS, MacLellan-Tobert, SG, Porter, CJ, Dangovian, MI, Jarandilla, R, Frumin, H, Milstein, S, Buetikofer, J, Lesser, J, Morillo, CA, Leitch, JW, Yee, R, McLaran, CJ, Gersh, BJ, Osborn, MJ, Nelson, S, Stanley, M, Love, C, Susmano, A, Volgman, AS, Buckingham, TA, Strieper, MJ, Campbell, R, Grubb, BP, Wolfe, D & Samoil, D 1995, 'Neurally mediated syncope: Pathogenesis, diagnosis, and treatment', Neurology, vol. 45, no. 4, pp. S12-S18.
Kaufmann H, Savage DD, Corwin L, McGee DL, Gendelman HE, Linzer M et al. Neurally mediated syncope: Pathogenesis, diagnosis, and treatment. Neurology. 1995 Jan 1;45(4):S12-S18.
Kaufmann, Horacio ; Savage, D. D. ; Corwin, L. ; McGee, D. L. ; Gendelman, Howard Eliot ; Linzer, M. ; Gabelman, M. ; Day, S. C. ; Cook, E. F. ; Funkenstein, H. ; Lewis, T. ; Ziegler, M. G. ; Lake, C. R. ; Kopin, I. J. ; Bannister, R. ; Sever, P. ; Gross, M. ; Oribe, E. ; Kaufmann, H. ; Winters, S. ; Sneddon, J. F. ; Counihan, P. J. ; Bashir, Y. ; Boudoulas, H. ; Weissler, A. M. ; Lewis, R. P. ; Weiss, S. ; Baker, J. P. ; Dehn, T. C. ; Morley, C. A. ; Sutton, R. ; Mathias, C. J. ; Armstrong, E. ; Browse, N. ; Shaw, E. C. ; Young, H. H. ; Kapoor, W. N. ; Peterson, J. R. ; Karpf, M. ; Palmer, E. D. ; Mark, A. L. ; Abboud, F. M. ; Oberg, B. ; Thoren, P. ; Thoren, P. ; Skarphedinsson, J. O. ; Carlsson, S. ; Jarisch, A. ; Zotterman, Y. ; Shalev, Y. ; Gal, R. ; Tchou, P. J. ; Oribe, E. ; Kaufmann, H. ; Scherrer, U. ; Vissing, S. ; Morgan, B. J. ; Fitzpatrick, A. P. ; Bannder, N. ; Cheng, A. ; Maloney, T. D. ; Jaeger, F. J. ; Fouad-Tarazi, F. M. ; Milstein, S. ; Buetikofer, J. ; Lesser, J. ; Sra, J. S. ; Jazayeri, M. R. ; Avitall, B. ; Barcroft, H. ; Edholm, O. G. ; Barcroft, H. ; McMichael, J. ; Sharpey-Shafer, E. P. ; Epstein, S. E. ; Stampfer, M. ; Beiser, D. ; Murray, R. H. ; Thompson, L. J. ; Bowers, J. A. ; Wallin, B. G. ; Sundlof, G. ; Wallin, B. G. ; Westerberg, C. E. ; Sundloff, G. ; Burke, D. ; Sundloff, G. ; Wallin, G. ; Kaufmann, H. ; Oribe, E. ; Oliver, J. A. ; Kaufmann, H. ; Oribe, E. ; Miller, M. ; Glover, W. E. ; Greenfield, A. D.M. ; Shanks, R. G. ; Robinson, B. J. ; Johnson, R. H. ; Robertson, D. ; Johnson, G. A. ; Robertson, R. M. ; Palmer, R. M. ; Ashton, D. S. ; Moncada, S. ; Moncada, S. ; Palmer, R. M. ; Higgs, E. A. ; Bolotina, V. ; Najibi, S. ; Palacino, J. ; Tolins, J. ; Palmer, R. M.J. ; Moncada, S. ; Kaufmann, H. ; Berman, J. ; Oribe, E. ; Kenny, R. A. ; Ingram, A. ; Bayliss, J. ; Fitzpatrick, A. ; Sutton, R. ; Abi-Samra, F. ; Maloney, J. D. ; Fouad-Tarazi, F. ; Almquist, A. ; Goldenberg, I. F. ; Milstein, S. ; Kaufmann, H. ; Oribe, E. ; Winters, S. ; Strasberg, B. ; Rechavia, E. ; Sagie, A. ; Raviele, A. ; Gasparini, G. ; Di Pede, F. ; Grubb, B. P. ; Temsey-Armos, P. ; Hahn, H. ; Brignole, M. ; Menozzi, C. ; Gianfranchi, L. ; Sra, J. S. ; Anderson, A. J. ; Sheik, S. H. ; Sheldon, R. ; Killam, S. ; Waxman, M. B. ; Yao, L. ; Cameron, D. A. ; Kapoor, W. N. ; Brant, N. ; Raviele, A. ; Gasparini, G. ; Di Pede, F. ; Micieli, G. ; Cavallini, A. ; Tasorelli, C. ; El-Bedawi, K. M. ; Hainsworth, R. ; Oribe, E. ; Kaufmann, H. ; Winters, S. ; Davies, I. B. ; Bannister, R. ; Sever, P. S. ; Balaji, S. ; Oslizlok, P. C. ; Allen, M. C. ; Dacosta, D. ; McIntosh, S. ; Kenny, R. A. ; Thames, M. D. ; Abi Samra, F. M. ; Davison, N. M. ; Gardner, R. D. ; O'marcaigh, A. S. ; MacLellan-Tobert, S. G. ; Porter, C. J. ; Dangovian, M. I. ; Jarandilla, R. ; Frumin, H. ; Milstein, S. ; Buetikofer, J. ; Lesser, J. ; Morillo, C. A. ; Leitch, J. W. ; Yee, R. ; McLaran, C. J. ; Gersh, B. J. ; Osborn, M. J. ; Nelson, S. ; Stanley, M. ; Love, C. ; Susmano, A. ; Volgman, A. S. ; Buckingham, T. A. ; Strieper, M. J. ; Campbell, R. ; Grubb, B. P. ; Wolfe, D. ; Samoil, D. / Neurally mediated syncope : Pathogenesis, diagnosis, and treatment. In: Neurology. 1995 ; Vol. 45, No. 4. pp. S12-S18.
@article{5d641c608b8c4c48822dcbdebe849caf,
title = "Neurally mediated syncope: Pathogenesis, diagnosis, and treatment",
abstract = "Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.",
author = "Horacio Kaufmann and Savage, {D. D.} and L. Corwin and McGee, {D. L.} and Gendelman, {Howard Eliot} and M. Linzer and M. Gabelman and Day, {S. C.} and Cook, {E. F.} and H. Funkenstein and T. Lewis and Ziegler, {M. G.} and Lake, {C. R.} and Kopin, {I. J.} and R. Bannister and P. Sever and M. Gross and E. Oribe and H. Kaufmann and S. Winters and Sneddon, {J. F.} and Counihan, {P. J.} and Y. Bashir and H. Boudoulas and Weissler, {A. M.} and Lewis, {R. P.} and S. Weiss and Baker, {J. P.} and Dehn, {T. C.} and Morley, {C. A.} and R. Sutton and Mathias, {C. J.} and E. Armstrong and N. Browse and Shaw, {E. C.} and Young, {H. H.} and Kapoor, {W. N.} and Peterson, {J. R.} and M. Karpf and Palmer, {E. D.} and Mark, {A. L.} and Abboud, {F. M.} and B. Oberg and P. Thoren and P. Thoren and Skarphedinsson, {J. O.} and S. Carlsson and A. Jarisch and Y. Zotterman and Y. Shalev and R. Gal and Tchou, {P. J.} and E. Oribe and H. Kaufmann and U. Scherrer and S. Vissing and Morgan, {B. J.} and Fitzpatrick, {A. P.} and N. Bannder and A. Cheng and Maloney, {T. D.} and Jaeger, {F. J.} and Fouad-Tarazi, {F. M.} and S. Milstein and J. Buetikofer and J. Lesser and Sra, {J. S.} and Jazayeri, {M. R.} and B. Avitall and H. Barcroft and Edholm, {O. G.} and H. Barcroft and J. McMichael and Sharpey-Shafer, {E. P.} and Epstein, {S. E.} and M. Stampfer and D. Beiser and Murray, {R. H.} and Thompson, {L. J.} and Bowers, {J. A.} and Wallin, {B. G.} and G. Sundlof and Wallin, {B. G.} and Westerberg, {C. E.} and G. Sundloff and D. Burke and G. Sundloff and G. Wallin and H. Kaufmann and E. Oribe and Oliver, {J. A.} and H. Kaufmann and E. Oribe and M. Miller and Glover, {W. E.} and Greenfield, {A. D.M.} and Shanks, {R. G.} and Robinson, {B. J.} and Johnson, {R. H.} and D. Robertson and Johnson, {G. A.} and Robertson, {R. M.} and Palmer, {R. M.} and Ashton, {D. S.} and S. Moncada and S. Moncada and Palmer, {R. M.} and Higgs, {E. A.} and V. Bolotina and S. Najibi and J. Palacino and J. Tolins and Palmer, {R. M.J.} and S. Moncada and H. Kaufmann and J. Berman and E. Oribe and Kenny, {R. A.} and A. Ingram and J. Bayliss and A. Fitzpatrick and R. Sutton and F. Abi-Samra and Maloney, {J. D.} and F. Fouad-Tarazi and A. Almquist and Goldenberg, {I. F.} and S. Milstein and H. Kaufmann and E. Oribe and S. Winters and B. Strasberg and E. Rechavia and A. Sagie and A. Raviele and G. Gasparini and {Di Pede}, F. and Grubb, {B. P.} and P. Temsey-Armos and H. Hahn and M. Brignole and C. Menozzi and L. Gianfranchi and Sra, {J. S.} and Anderson, {A. J.} and Sheik, {S. H.} and R. Sheldon and S. Killam and Waxman, {M. B.} and L. Yao and Cameron, {D. A.} and Kapoor, {W. N.} and N. Brant and A. Raviele and G. Gasparini and {Di Pede}, F. and G. Micieli and A. Cavallini and C. Tasorelli and El-Bedawi, {K. M.} and R. Hainsworth and E. Oribe and H. Kaufmann and S. Winters and Davies, {I. B.} and R. Bannister and Sever, {P. S.} and S. Balaji and Oslizlok, {P. C.} and Allen, {M. C.} and D. Dacosta and S. McIntosh and Kenny, {R. A.} and Thames, {M. D.} and {Abi Samra}, {F. M.} and Davison, {N. M.} and Gardner, {R. D.} and O'marcaigh, {A. S.} and MacLellan-Tobert, {S. G.} and Porter, {C. J.} and Dangovian, {M. I.} and R. Jarandilla and H. Frumin and S. Milstein and J. Buetikofer and J. Lesser and Morillo, {C. A.} and Leitch, {J. W.} and R. Yee and McLaran, {C. J.} and Gersh, {B. J.} and Osborn, {M. J.} and S. Nelson and M. Stanley and C. Love and A. Susmano and Volgman, {A. S.} and Buckingham, {T. A.} and Strieper, {M. J.} and R. Campbell and Grubb, {B. P.} and D. Wolfe and D. Samoil",
year = "1995",
month = "1",
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language = "English (US)",
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pages = "S12--S18",
journal = "Neurology",
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}

TY - JOUR

T1 - Neurally mediated syncope

T2 - Pathogenesis, diagnosis, and treatment

AU - Kaufmann, Horacio

AU - Savage, D. D.

AU - Corwin, L.

AU - McGee, D. L.

AU - Gendelman, Howard Eliot

AU - Linzer, M.

AU - Gabelman, M.

AU - Day, S. C.

AU - Cook, E. F.

AU - Funkenstein, H.

AU - Lewis, T.

AU - Ziegler, M. G.

AU - Lake, C. R.

AU - Kopin, I. J.

AU - Bannister, R.

AU - Sever, P.

AU - Gross, M.

AU - Oribe, E.

AU - Kaufmann, H.

AU - Winters, S.

AU - Sneddon, J. F.

AU - Counihan, P. J.

AU - Bashir, Y.

AU - Boudoulas, H.

AU - Weissler, A. M.

AU - Lewis, R. P.

AU - Weiss, S.

AU - Baker, J. P.

AU - Dehn, T. C.

AU - Morley, C. A.

AU - Sutton, R.

AU - Mathias, C. J.

AU - Armstrong, E.

AU - Browse, N.

AU - Shaw, E. C.

AU - Young, H. H.

AU - Kapoor, W. N.

AU - Peterson, J. R.

AU - Karpf, M.

AU - Palmer, E. D.

AU - Mark, A. L.

AU - Abboud, F. M.

AU - Oberg, B.

AU - Thoren, P.

AU - Thoren, P.

AU - Skarphedinsson, J. O.

AU - Carlsson, S.

AU - Jarisch, A.

AU - Zotterman, Y.

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PY - 1995/1/1

Y1 - 1995/1/1

N2 - Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.

AB - Neurally mediated syncope is the most frequent cause of syncope in patients who do not have structural heart disease.Neurally mediated syncope is believed to be a reflex triggered by excessive afferent discharge from mechanoreceptors located in the arterial tree or viscera, particularly the left ventricle of the heart. In response to these signals, a CNS-mediated sudden rise in parasympathetic efferent activity occurs, causing relative or absolute bradycardia and sympathoinhibition with arterial vasodilation and hypotension. Although our understanding of the pathophysiology of this syndrome is still incomplete, it is well established that sympathetic nerve activity and norepinephrine release fall inappropriately during neurally mediated syncope, whereas appropriate increases in plasma concentrations of epinephrine, angiotensin II, vasopressin, and endothelin-1 occur. Recent studies from our laboratory suggest that synthesis of the vasodilator nitric oxide increases during neurally mediated syncope. This suggests that nitric oxide-mediated arterial vasodilation could contribute to the profound hypotension characteristic of this syndrome. The diagnosis of neurally mediated syncope can be made with acceptable levels of specificity and sensitivity by the upright tilt test. Explaining the mechanisms responsible for arterial vasodilation in neurally mediated syncope may lead to effective treatment.

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UR - http://www.scopus.com/inward/citedby.url?scp=0029285108&partnerID=8YFLogxK

M3 - Article

VL - 45

SP - S12-S18

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 4

ER -