Vasovagal Syncope, Orthostatic Hypotension and Postural Orthostatic Tachycardia Syndrome: Is There a Connection?

  • A. Gonzalez-Hermosillo
  • M. F. Marquez
  • A. Kostine
  • K. Jauregui-Renaud
  • M. Cardenas
Conference paper


Orthostatic intolerance is the development of symptoms during standing, which are relieved when the subject adopts a recumbent posture. Approximately 500,000 Americans are affected by this syndrome. Patients with orthostatic intolerance often complain of exercise intolerance, lightheadedness, dizziness, palpitations, disabling fatigue, blurred vision, headache, anxiety, depression, cold sweating, nausea, chest discomfort, and dyspnea. Sometimes these symptoms are prodromal for an impending syncopal event. Often, however, loss of consciousness occurs without warning. Presyncope or syncope is merely an extreme expression of this spectrum of symptoms.


Heart Rate Variability Orthostatic Hypotension Muscle Sympathetic Nerve Activity Cerebral Blood Flow Velocity Cerebral Hypoperfusion 


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  1. 1.
    Hermosillo AG (2001) Orthostatic hypotension, 2001. Cardiol Rev 9:339–347PubMedCrossRefGoogle Scholar
  2. 2.
    Grubb BP, Gerard G, Roush K et al (1991) Cerebral vasoconstriction during head upright tilt-induced vasovagal syncope: a paradoxic and unexpected response. Circulation 84:1157–1164PubMedCrossRefGoogle Scholar
  3. 3.
    Fredman CS, Bierman KM, Patel V et al (1995) Transcranial Doppler ultrasonography during head upright tilt-table testing. Ann Intern Med 123:848–849PubMedGoogle Scholar
  4. 4.
    Carey BJ, Manktelow BN, Panerai RB et al (2001) Dynamic cerebral autoregulatory responses to head-up tilt in normal subjects and patients with recurrent vasovagal syncope. Circulation 104:898–902PubMedCrossRefGoogle Scholar
  5. 5.
    Sung RYT, Yu CW, Yam MC et al (2000) Cerebral blood flow during vasovagal syncope induced by active standing or head up tilt. Arch Dis Child 82:154–158PubMedCrossRefGoogle Scholar
  6. 6.
    Carey BJ, Eames PJ, Panerai RB et al (2001) Carbon dioxide, critical closing pressure and cerebral hemodynamics prior to vasovagal syncope in humans. Clin Sci 101:351–358PubMedCrossRefGoogle Scholar
  7. 7.
    Grubb BP, Kosinski D (2002) Evaluation and management of syncope. In: Ganz LI (ed) Management of cardiac arrhythmias. Humana, Totowa, NJ, pp 183–207Google Scholar
  8. 8.
    Fitzpatrick AP, Banner N, Cheng A et al (1993) Vasovagal syncope may occur alter orthotopic heart transplantation. J Am Coll Cardiol 21:1138–1141CrossRefGoogle Scholar
  9. 9.
    Mosqueda-Garcia R, Burlan R, Tank J et al (2000) The elusive pathophysiology of neurally mediated syncope. Circulation 102:2898–2906PubMedCrossRefGoogle Scholar
  10. 10.
    Malik M (1996) Task force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Eur Heart J 17:354–381CrossRefGoogle Scholar
  11. 11.
    Lipsitz LA, Mietus J, Moody GB et al (1990) Spectral characteristics of heart rate variability before and during postural tilt: relations to aging and risk of syncope. Circulation 81:1803–1810PubMedCrossRefGoogle Scholar
  12. 12.
    Alehan D, Ayabakan C, Özer S (2002) Heart rate variability and autonomic nervous system changes in children with vasovagal syncope. Pacing Clin Electrophysiol 25:1331–1338PubMedCrossRefGoogle Scholar
  13. 13.
    Morillo CA, Klein GJ, Jones DL et al (1994) Time and frequency domain analysis of heart rate variability during orthostatic stress in patients with neurally mediated syncope. Am J Cardiol 74:1258–1262PubMedCrossRefGoogle Scholar
  14. 14.
    Furlan R, Piazza S, Dell’Orto S et al (1998) Cardiac autonomic patterns preceding occasional vasovagal reactions in healthy humans. Circulation 98:1756–1761PubMedCrossRefGoogle Scholar
  15. 15.
    Mosqueda-Garcia R, Furlan R, Fernandez-Violante R et al (1997) Sympathetic and baroreceptor reflex function in neurally mediated syncope evoked by tilt. J Clin Invest 99:2736–2744PubMedCrossRefGoogle Scholar
  16. 16.
    Béchir M, Binggeli C, Corti R et al (2003) Dysfunctional baroreflex regulation of sympathetic nerve activity in patients with vasovagal syncope. Circulation 107:1620–1625PubMedCrossRefGoogle Scholar
  17. 17.
    Novak V, Spies J, Novak P et al (1998) Hypocapnia and cerebral hypoperfusion in orthostatic intolerance. Stroke 2:1876–1881CrossRefGoogle Scholar
  18. 18.
    Jordan J, Shannon JR, Diedrich A et al (2000) Interaction of carbon dioxide and sympathetic nervous system activity in the regulation of cerebral perfusion in humans. Hypertension 36:383–388PubMedCrossRefGoogle Scholar
  19. 19.
    Jauregui-Renaud K, Marquez MF, Hermosillo AG et al (2003) Paced breathing can prevent vasovagal syncope during head-up tilt testing. Can J Cardiol 19:698–700PubMedGoogle Scholar
  20. 20.
    Hermosillo AG, Jáuregui-Renaud K, Kostine A et al (2002) Comparative study of cerebral blood flow between postural tachycardia and neurocardiogenic syncope during head-up tilt test. Europace 4:369–374PubMedCrossRefGoogle Scholar
  21. 21.
    Jacob G, Atkinson D, Jordan J et al (1999) Effects of standing on cerebrovascular resistance in patients with idiopathic orthostatic intolerance. Am J Med 106:59–64PubMedCrossRefGoogle Scholar
  22. 22.
    Grubb B, Kanjwal M, Kosinski DJ. (2001) The postural orthostatic tachycardia syndrome: current concepts in pathophysiology diagnosis and management (review). J Interv Card Electrophysiol 5:9–16PubMedCrossRefGoogle Scholar
  23. 23.
    Streeten DHP, Anderson GH Jr, Richardson R et al (1988) Abnormal orthostatic changes in blood pressure and heart rate in subjects with intact sympathetic nervous function: evidence for excessive venous pooling. J Lab Clin Med 111:326–335PubMedGoogle Scholar
  24. 24.
    Streeten DHP (1999) Orthostatic intolerance: a historical introduction to pathophysiology mechanisms. Am J Med Sci 317:78–87PubMedCrossRefGoogle Scholar
  25. 25.
    Burlan R, Jacob G, Snell M et al (1998) Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control. Circulation 98:2154–2159CrossRefGoogle Scholar
  26. 26.
    Schondorf R, Low P (1993) Idiopathic postural tachycardia syndromes. In: Low P (ed) Clinical autonomie disorders. Little Brown, Boston, pp 641–652Google Scholar
  27. 27.
    Jacob G, Shannon J, Costa F et al (1999) Abnormal norepinephrine clearance and adrenergic receptor sensitivity in idiopathic orthostatic intolerance. Circulation 98:2154–2159Google Scholar
  28. 28.
    Shannon JR, Flattern NI, Jordan J et al (2000) Orthostatic intolerance and tachycardia associated with norepinephrine-transporter deficiency. N Engl J Med 342:541–549PubMedCrossRefGoogle Scholar
  29. 29.
    Morillo CA, Eckberg DL, Ellenbogen KA et al (1997) Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 96:2509–2513PubMedCrossRefGoogle Scholar
  30. 30.
    Narkiewicz K, Somers V (1998) Chronic orthostatic intolerance: part of a spectrum of dysfunction in orthostatic cardiovascular homeostasis. Circulation 98:2105–2107PubMedCrossRefGoogle Scholar
  31. 31.
    Suzuki M, Hori S, Nakamura I et al (2003) Role of vagal control in vasovagal syncope. Pacing Clin Electrophysiol 26:571–578PubMedCrossRefGoogle Scholar
  32. 32.
    Grubb BP, Karas B (1999) Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: an overview of classification, clinical evaluation, and management. Pacing Clin Electrophysiol 22:798–810PubMedCrossRefGoogle Scholar
  33. 33.
    Beck L, Pons M, Piot C et al (1999) A “dysautonomic” head-up tilt test pattern in elderly patients with neurocardiogenic syncope. Pacing Clin Electrophysiol 22:104–1012CrossRefGoogle Scholar
  34. 34.
    Robertson D, Low PA, Polinsky RJ (1996) Primer on the autonomic nervous system. Academic Press, San DiegoGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • A. Gonzalez-Hermosillo
    • 1
  • M. F. Marquez
    • 1
  • A. Kostine
    • 1
  • K. Jauregui-Renaud
    • 1
  • M. Cardenas
    • 1
  1. 1.Department of Cardiac ElectrophysiologyInstituto Nacional de Cardiologia “Ignacio Chavez”Mexico CityMexico

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