Clinical features of prolonged tilt-induced hypotension with an apparent vasovagal mechanism, but without syncope

Geoffrey Heyer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: A previous study of electroencephalography (EEG) changes with syncope led to a finding that some young patients develop prolonged periods of tilt-induced hypotension, but they do not lose consciousness. The present study aim was to compare patterns of hemodynamic changes, measures of duration, and sweating between these patients and patients with tilt-induced vasovagal syncope. Methods: In an observational study, qualitative changes in hemodynamic parameters were compared between patients with prolonged hypotension (n = 30) and with syncope (n = 30). To demonstrate that periods of hypotension far-exceed the typical presyncope period, several parameters were used to compare the durations of events between groups. Differences in sweating patterns were explored. Results: Parallels in hemodynamic changes were present in both groups suggesting similar vasovagal mechanisms. Patients with prolonged hypotension had longer durations of hypotension (165 ± 44 versus 57 ± 13 s, p < 0.001), diminished cardiac output (109 ± 38 versus 32 ± 9 s, p < 0.001), and EEG slowing (85 ± 31 versus 9 ± 4 s, p < 0.001) compared to patients with syncope. While all patients generated an increase in sweat rate, those with hypotension only developed a robust sweat response that always preceded the plateau in hypotension compared to 14 (47%) patients with syncope who developed an increase in sweating prior to syncope, p < 0.001. Conclusions: Similarities are present among hemodynamic changes with prolonged hypotension and with tilt-induced vasovagal syncope, suggesting a possible vasovagal mechanism for prolonged hypotension. If true, understanding why some individuals develop a vasovagal response that does not culminate in rapid syncope may help to elucidate the physiologic underpinnings of the vasovagal reflex.

Original languageEnglish (US)
Pages (from-to)87-93
Number of pages7
JournalAutonomic Neuroscience: Basic and Clinical
Volume218
DOIs
StatePublished - May 1 2019

Fingerprint

Controlled Hypotension
Syncope
Hypotension
Sweating
Hemodynamics
Vasovagal Syncope
Sweat
Electroencephalography
Consciousness
Cardiac Output
Observational Studies
Reflex

Keywords

  • Adolescent
  • Near-syncope
  • Orthostatic hypotension
  • Pediatric
  • Presyncope

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Clinical Neurology
  • Cellular and Molecular Neuroscience

Cite this

Clinical features of prolonged tilt-induced hypotension with an apparent vasovagal mechanism, but without syncope. / Heyer, Geoffrey.

In: Autonomic Neuroscience: Basic and Clinical, Vol. 218, 01.05.2019, p. 87-93.

Research output: Contribution to journalArticle

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