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European Heart Journal 1996 17(11):1729-1736;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Role of endogenous opioids and catecholamines in vasovagal syncope

D. R. Wallbridge, H. E. Maclntyre*, C. E. Gray*, K. G. Oldroyd, A. P. Rae and S. M. Cobbe

*Departments of Medical Cardiology and Pathological Biochemistry Glasgow G31 2ER, U.K.
Royal Infirmary Glasgow G31 2ER, U.K.

Received 14 February 1996; accepted 26 February 1996.

Correspondence. Professor S. M. Cobbe, Department of Medical Cardiology, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, U.K

Abstract

Head-up tilt testing demonstrates vasovagal mechanisms as a cause for syncope, but the pathophysiology underlying this condition remains unclear. The aim of this study was (i) to measure plasma ß-endorphins, adrenocorticotrophic hormone, cortisol, catecholamines, and brain natriuretic peptide during head-up tilt, and (ii) to assess the effect of naloxone infusion during head-up tilt in subjects with reproducible vasovagal syncope. During the assessment of unexplained syncope, 71 subjects underwent a total of 93 tilt tests (60–70° head upwards for 40–45 min or until syncope occurred) during which frequent blood sampling was performed. Subjects with a positive tilt test (n=56) (mean duration to syncope 23.6 min) showed a larger rise in ß-endorphin levels prior to syncope (baseline 4.7 ± 2.2 vs syncope onset 6.9 ± 3.2 pmol . 1–1, P=0.0001) than those with a negative test (n=37) (baseline 39 ± 3.9 vs end of test 4.9 ± 2.3 pmol. 1–1, P=0.03). During tilting, adrenocorticotrophic hormone, cortisol, and noradrenaline increased; adrenaline and brain natriuretic peptide remained unchanged; and these responses were similar in positive and negative test groups. Naloxone (2.6 mg. kg–1 i.v. bolus followed by 20 µg. kg –1. min –1 infusion), administered in a double-blind fashion during head-up tilt in nine subjects, failed tomodify either the time to syncope or the vasodepressor response. Thus, endogenous opioids appear not to be an important trigger for vasovagal syncope, and other pathophysiological mechanisms should be considered.

Key Words: Vasovagal syncope • tilt-testing • opioids • ß-endorphin • naloxone • catecholamines


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