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European Heart Journal Advance Access originally published online on July 20, 2009
European Heart Journal 2009 30(18):2174-2176; doi:10.1093/eurheartj/ehp290
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Tilt testing and neurally mediated syncope: too many protocols for one condition or specific protocols for different situations?

Angel Moya*

Arrhythmia Unit, Department of Cardiology, University Hospital Vall d'Hebrón, 08035 Barcelona, Spain

* Corresponding author. Tel: +34 932746166, Fax: +34 932746002, Email: 11193amm@comb.es; amoya@comb.es

This editorial refers to ‘Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing’{dagger}, by P. Flevari et al., on page 2249

The first 10% of the full text of this article appears below.

Syncope, defined as a transient loss of consciousness due to transient global cerebral hypoperfusion, characterized by rapid onset, short duration, and spontaneous complete recovery, is a frequent symptom and can be attributed to different causes.1

The most common aetiology of syncope is a neurally mediated reflex that consists of a transient failure of the cardiovascular mechanisms that normally control haemodynamic stability. This reflex is usually triggered by different stimuli (afferent pathways), leading to sudden withdrawal of sympathetic activity and to an increase in parasympathetic nerve tone (efferent pathways), causing vasodilatation, with consequent hypotension, and bradycardia.

The clinical presentation of neurally mediated syncope is not usually uniform; however, it may manifest with different patterns. In some patients, it is initiated by clear adrenergic stimuli such as fear, pain, emotional distress, or medical instrumentation, . . . [Full Text of this Article]


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Related articles in EHJ:

Recurrent vasovagal syncope: comparison between clomipramine and nitroglycerin as drug challenges during head-up tilt testing
Panayota Flevari, Dionyssios Leftheriotis, Christophoros Komborozos, Katerina Fountoulaki, Nikolaos Dagres, George Theodorakis, and Dimitrios Kremastinos
EHJ 2009 30: 2249-2253. [Abstract] [Full Text]