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Syncope pp 15-25 | Cite as

Pathophysiology of Syncope

  • Michele Brignole
  • David G. Benditt
Chapter

Abstract

As has been already introduced in Chapter 1, syncope is caused by a self-limited, relatively brief period of inadequate delivery of oxygen, glucose, and other nutrients to brain tissues.1, 2 Since neuronal tissue has very limited energy storage capability, a well-maintained flow of oxygenated blood to the brain is crucial.

Keywords

Cerebral Blood Flow Autonomic Nervous System Cerebral Perfusion Pressure Systemic Arterial Pressure Cerebral Hypoperfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Moya A, et al. Guidelines for the diagnosis and management of syncope (version 2009). The task force for the diagnosis and management of syncope of the European Society of Cardiology (ESC). Eur Heart J. 2009;30:2631–2671.PubMedCrossRefGoogle Scholar
  2. 2.
    Brignole M, et al. Guidelines on management (diagnosis and treatment) of syncope – update 2004. Europace. 2004;6:467–537.PubMedCrossRefGoogle Scholar
  3. 3.
    Rowell LB. Human circulation. Regulation during physical stress. New York, NY: Oxford University Press; 1986.Google Scholar
  4. 4.
    Folino FA. Cerebral autoregulation and syncope. Prog Cardiovasc Dis. 2007;50:49–80.CrossRefGoogle Scholar
  5. 5.
    Schondorf R, et al. Cerebral autoregulation in orthostatic intolerance. Ann N Y Acad Sci. 2001;940:514–526.PubMedCrossRefGoogle Scholar
  6. 6.
    Iwasaki K, et al. Human cerebral autoregulation before, during and after spaceflight. J Physiol. 2007;579:799–810.PubMedCrossRefGoogle Scholar
  7. 7.
    Ogoh S. Autonomic control of cerebral circulation: exercise. Med Sci Sports Exerc. 2008;40:2046–2054.PubMedCrossRefGoogle Scholar
  8. 8.
    Xu W-H, et al. Disparate cardio-cerebral vascular modulation during standing in multiple system atrophy and Parkinson disease. J Neurologic Sci. 2009;276:84–87.CrossRefGoogle Scholar
  9. 9.
    Brodie FG, et al. Long-term changes in dynamic cerebral autoregulation: a 10 years follow up study. Clin Physiol Funct Imaging. 2009;29:366–371.PubMedCrossRefGoogle Scholar
  10. 10.
    Low PA. Autonomic nervous system function. J Clin Neurophys. 1993;10:14–27.CrossRefGoogle Scholar
  11. 11.
    Low PA, et al. Prospective evaluation of clinical characteristics of orthostatic hypotension. Mayo Clin Proc. 1995;70:617–622.PubMedCrossRefGoogle Scholar
  12. 12.
    Mathias CJ. Autonomic diseases – clinical features and laboratory evaluation. J Neurol Neurosurg Psychiatr. 2003;74:31–41.Google Scholar
  13. 13.
    Mathias CJ. Role of autonomic evaluation in the diagnosis and management of syncope. Clin Auton Res. 2004;14(S1):45–54.PubMedCrossRefGoogle Scholar
  14. 14.
    Freeman R. Autonomic peripheral neuropathy. Neurol Clinics. 2007;25:277–301.CrossRefGoogle Scholar
  15. 15.
    Edmonds ME, Sturrock RD. Autonomic neuropathy in the Guillian-Barre syndrome. Brit Med J. 1979;2:668–670.PubMedCrossRefGoogle Scholar
  16. 16.
    Vernino S, Lennon VA. Neuronal ganglionic acetylcholine receptor autoimmunity. Ann N Y Acad Sci. 2003;998:211–214.PubMedCrossRefGoogle Scholar
  17. 17.
    Vernino S, et al. Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. New Engl J Med. 200;343:847–855.Google Scholar
  18. 18.
    Camdessanche JP, et al. Paraneoplastic peripheral neuropathy associated with anti-Hu antibodies. A clinical and electrophysiological study of 20 patients. Brain. 2002;125:166–175.PubMedCrossRefGoogle Scholar
  19. 19.
    van Dijk JG, et al. A guide to disorders causing transient loss of consciousness: focus on syncope. Nature Rev Neurosci. 2009;5:438–448.Google Scholar
  20. 20.
    Verheyden B, et al. Steep fall in cardiac output is main determinant of hypotension during drug-free and nitroglycerine-induced orthostatic vasovagal syncope. Heart Rhythm. 2008;5:1695–1701.PubMedCrossRefGoogle Scholar
  21. 21.
    Wieling W, Schatz IJ. The consensus statement on the definition of orthostatic hypotension: a revisit after 13 years. J Hyperten. 2009;27:935–938.CrossRefGoogle Scholar
  22. 22.
    Garcin B, et al. Reversible cerebral vasoconstriction syndrome. J Clin Neurosci. 2009;16: 147–150.PubMedCrossRefGoogle Scholar
  23. 23.
    Ducros A, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain. 2007;130:3091–3101.PubMedCrossRefGoogle Scholar
  24. 24.
    Silvani S, et al. Cerebral vasoconstriction in neurally mediated syncope: relationship with type of head-up tilt test response. Ital Heart J. 2003;4:768–775.PubMedGoogle Scholar
  25. 25.
    Grubb BP, et al. Cerebral syncope: loss of consciousness associated with cerebral vasoconstriction in the absence of systemic hypotension. Pacing Clin Electrophysiol. 1998;21: 652–658.PubMedCrossRefGoogle Scholar
  26. 26.
    Atwood JE, et al. Exercise testing in patients with aortic stenosis. Chest. 1988;93:1083–1087.PubMedCrossRefGoogle Scholar
  27. 27.
    Johnson AM. Aortic stenosis, sudden death and the left ventricular baroreceptors. Br Heart J. 1971;33:1–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Leitch JW. Syncope associated with supraventricular tachycardia: An expression of tachycardia or vasomotor response. Circulation. 1992;85:1064–1071.PubMedCrossRefGoogle Scholar
  29. 29.
    Giese AE, et al. Impact of age and blood pressure on the lower arterial pressure limit for maintenance of consciousness during passive upright posture in healthy vasovagal fainters: preliminary observations. Europace. 2004;6:457–462.PubMedCrossRefGoogle Scholar
  30. 30.
    Gisolf J, et al. Human cerebral venous outflow pathway depends on posture and central venous pressure. J Physiol. 2004;560:317–327.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Dipartimento di Cardiologia, Centro AritmologicoOspedali del TigullioLavagnaItaly
  2. 2.Cardiac Arrhythmia CenterMedical School, University of MinnesotaMinneapolisUSA

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