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Harford M, Villarroel M, Jorge J, Redfern O, Finnegan E, Davidson S, Young JD, Tarassenko L, Watkinson P. Contactless skin perfusion monitoring with video cameras: tracking pharmacological vasoconstriction and vasodilation using photoplethysmographic changes. Physiol Meas 2022; 43. [PMID: 36270506 DOI: 10.1088/1361-6579/ac9c82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/21/2022] [Indexed: 02/07/2023]
Abstract
Objectives.Clinical assessment of skin perfusion informs prognosis in critically ill patients. Video camera monitoring could provide an objective, continuous method to monitor skin perfusion. In this prospective, interventional study of healthy volunteers, we tested whether video camera-derived photoplethysmography imaging and colour measurements could detect drug-induced skin perfusion changes.Approach.We monitored the lower limbs of 30 volunteers using video cameras while administering phenylephrine (a vasoconstrictor) and glyceryl trinitrate (a vasodilator). We report relative pixel intensity changes from baseline, as absolute values are sensitive to environmental factors. The primary outcome was the pre- to peak- infusion green channel amplitude change in the pulsatile PPGi waveform component. Secondary outcomes were pre-to-peak changes in the photoplethysmographic imaging waveform baseline, skin colour hue and skin colour saturation.Main results.The 30 participants had a median age of 29 years (IQR 25-34), sixteen (53%) were male. A 34.7% (p= 0.0001) mean decrease in the amplitude of the pulsatile photoplethysmographic imaging waveform occurred following phenylephrine infusion. A 30.7% (p= 0.000004) mean increase occurred following glyceryl trinitrate infusion. The photoplethysmographic imaging baseline decreased with phenylephrine by 2.1% (p= 0.000 02) and increased with glyceryl trinitrate by 0.5% (p= 0.026). Skin colour hue changed in opposite direction with phenylephrine (-0.0013,p= 0.0002) and glyceryl trinitrate (+0.0006,p= 0.019). Skin colour saturation decreased with phenylephrine by 0.0022 (p= 0.0002), with no significant change observed with glyceryl trinitrate (+0.0005,p= 0.21).Significance.Drug-induced vasoconstriction and vasodilation are associated with detectable changes in photoplethysmographic imaging waveform parameters and skin hue. Our findings suggest video cameras have great potential for continuous, contactless skin perfusion monitoring.
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Affiliation(s)
- M Harford
- Critical Care Research Group, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.,Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - M Villarroel
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - J Jorge
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - O Redfern
- Critical Care Research Group, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - E Finnegan
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - S Davidson
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - J D Young
- Critical Care Research Group, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - L Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - P Watkinson
- Critical Care Research Group, Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Wang Y, Wang Y, He B, Tao C, Han Z, Liu P, Wang Y, Tang C, Liu X, Du J, Jin H. Plasma human growth cytokines in children with vasovagal syncope. Front Cardiovasc Med 2022; 9:1030618. [PMID: 36312268 PMCID: PMC9614254 DOI: 10.3389/fcvm.2022.1030618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The study was designed to investigate the profile of plasma human growth cytokines in pediatric vasovagal syncope (VVS). Materials and methods In the discovery set of the study, plasma human growth cytokines were measured using a Quantiboby Human Growth Factor Array in 24 VVS children and 12 healthy controls. Scatter and principal component analysis (PCA) diagrams were used to describe the samples, an unsupervised hierarchical clustering analysis was used to categorize the samples. Subsequently, the cytokines obtained from the screening assays were verified with a suspension cytokine array in the validation set of the study including 53 VVS children and 24 controls. Finally, the factors associated with pediatric VVS and the predictive value for the diagnosis of VVS were determined. Results In the discovery study, the differential protein screening revealed that the plasma hepatocyte growth factor (HGF), transforming growth factor b1 (TGF-b1), insulin-like growth factor binding protein (IGFBP)-4, and IGFBP-1 in children suffering from VVS were higher than those of the controls (all adjust P- value < 0.05). However, the plasma IGFBP-6, epidermal growth factor (EGF), and IGFBP-3 in pediatric VVS were lower than those of the controls (all adjust P- value < 0.01). Meanwhile, the changes of 7 differential proteins were analyzed by volcano plot. Unsupervised hierarchical cluster analysis demonstrated that patients in the VVS group could be successfully distinguished from controls based on the plasma level of seven differential proteins. Further validation experiments showed that VVS patients had significantly higher plasma concentrations of HGF, IGFBP-1, and IGFBP-6, but lower plasma concentrations of EGF and IGFBP-3 than controls. The logistics regression model showed that increased plasma concentration of HGF and IGFBP-1 and decreased plasma concentration of EGF were correlated with the development of pediatric VVS. ROC curve analysis showed that the abovementioned 3 proteins were useful for assisting the diagnosis of VVS. Conclusion Plasma human growth cytokine profiling changed in pediatric VVS. Elevated plasma concentrations of HGF and IGFBP-1, and decreased EGF were associated factors in the development of pediatric VVS. The abovementioned three proteins are helpful for the diagnosis of pediatric VVS.
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Affiliation(s)
- Yuanyuan Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yaru Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Bing He
- Department of Pediatrics, People’s Hospital of Wuhan University, Hubei, China
| | - Chunyan Tao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhenhui Han
- Department of Cardiology, Children’s Hospital of Kaifeng, Kaifeng, China
| | - Ping Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuli Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chaoshu Tang
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China,Department of Physiology and Pathophysiology, Health Science Centre, Peking University, Beijing, China
| | - Xueqin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China,Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China,*Correspondence: Junbao Du,
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China,Hongfang Jin,
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Atıcı A, Aciksari G, Baycan OF, Barman HA, Sonsöz MR, Sahin M, Asoglu R, Demirkıran A, Kul Ş, Gungor B, Durmaz E, Bilge AK, Sahin I. Serum Asymmetric Dimethylarginine Levels in Patients with Vasovagal Syncope. ACTA ACUST UNITED AC 2019; 55:medicina55110718. [PMID: 31671882 PMCID: PMC6915676 DOI: 10.3390/medicina55110718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Vasovagal syncope (VVS) is the most common cause of syncope and has multiple pathophysiological mechanisms. Asymmetric dimethylarginine (ADMA) is the major inhibitor of nitric oxide (NO). In this study, we aimed to investigate the relationship between plasma ADMA levels and syncope during the head-up tilt (HUT) test. Materials and Methods: Overall, 97 patients were included in this study. They were above 18 years of age and were admitted to our clinic with the complaint of at least one episode of syncope consistent with VVS. The HUT test was performed in all patients. Patients were divided into the following two groups based on the HUT test results: group 1 included 57 patients with a positive HUT test and group 2 included 35 patients with a negative HUT test. Blood samples were taken before and immediately after the HUT test to measure ADMA levels. Results: No significant intergroup differences were observed concerning gender and age (female gender 68% vs 60%; mean age 24.85 ± 4.01 vs 25.62 ± 3.54 years, respectively, for groups 1 and 2). ADMA values were similar between groups 1 and 2 before the HUT test [ADMA of 958 (544–1418) vs 951 (519–1269); p = 0.794]. In the negative HUT group, no significant differences were observed in ADMA levels before and after the HUT test [ADMA of 951 (519–1269) vs 951 (519–1566); p = 0.764]. However, in the positive HUT group, ADMA levels were significantly decreased following the HUT test [pretest ADMA of 958 (544–1418) vs post-test ADMA of 115 (67–198); p < 0.001]. Conclusion: ADMA levels significantly decreased after the HUT test in patients with VVS.
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Affiliation(s)
- Adem Atıcı
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, 34722 Istanbul, Turkey.
| | - Gonul Aciksari
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, 34722 Istanbul, Turkey.
| | - Omer Faruk Baycan
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, 34722 Istanbul, Turkey.
| | - Hasan Ali Barman
- Cardiology Department, Okmeydani Training and Research Hospital, 34384 Istanbul, Turkey.
| | - Mehmet Rasih Sonsöz
- Cardiology Department, Istanbul University Istanbul School of Medicine, 34093 Istanbul, Turkey.
| | - Mustafa Sahin
- Biochemistry Department, Hitit University, Erol Olcok Training and Research Hospital, 19040 Corum, Turkey.
| | - Ramazan Asoglu
- Cardiology Department, Adiyaman Training and Research Hospital, 02200 Adiyaman, Turkey.
| | - Ahmet Demirkıran
- Cardiology Department, Istanbul University Istanbul School of Medicine, 34093 Istanbul, Turkey.
| | - Şeref Kul
- Cardiology Department, Istanbul Medeniyet University, Goztepe Training and Research Hospital, 34722 Istanbul, Turkey.
| | - Baris Gungor
- Department of Cardiology, Siyami Ersek Cardiothoracic Surgery Center, 34668 Istanbul, Turkey.
| | - Eser Durmaz
- Cardiology Department, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, 34096 Istanbul, Turkey.
| | - Ahmet Kaya Bilge
- Cardiology Department, Istanbul University Istanbul School of Medicine, 34093 Istanbul, Turkey.
| | - Irfan Sahin
- Cardiology Department, Bagcilar Training ve Research Hospital, Bagcilar Center, 34100 Istanbul, Turkey.
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Stewart JM, Shaban MA, Fialkoff T, Tuma‐Marcella B, Visintainer P, Terilli C, Medow MS. Mechanisms of tilt-induced vasovagal syncope in healthy volunteers and postural tachycardia syndrome patients without past history of syncope. Physiol Rep 2019; 7:e14148. [PMID: 31250563 PMCID: PMC6597794 DOI: 10.14814/phy2.14148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
Upright tilt table testing has been used to test for vasovagal syncope (VVS) but can result in "false positives" in which tilt-induced fainting (tilt+) occurs in the absence of real-world fainting. Tilt+ occurs in healthy volunteers and in patients with postural tachycardia syndrome (POTS) and show enhanced susceptibility to orthostatic hypotension. We hypothesized that the mechanisms for hypotensive susceptibility differs between tilt+ healthy volunteers (Control-Faint (N = 12)), tilt+ POTS patients (POTS-Faint (N = 12)) and a non-fainter control group of (Control-noFaint) (N = 10). Subjects were studied supine and during 70° upright tilt while blood pressure (BP), cardiac output (CO), and systemic vascular resistance (SVR), were measured continuously. Impedance plethysmography estimated regional blood volumes, flows, and vascular resistance. Heart rate was increased while central blood volume was decreased in both Faint groups. CO increased in Control-Faint because of reduced splanchnic vascular resistance; splanchnic pooling was similar to Control-noFaint. Splanchnic blood flow in POTS-Faint decreased and resistance increased similar to Control-noFaint but splanchnic blood volume was markedly increased. Decreased SVR and splanchnic arterial vasoconstriction is the mechanism for faint in Control-Faint. Decreased CO caused by enhanced splanchnic pooling is the mechanism for faint in POTS-Faint. We propose that intrahepatic resistance is increased in POTS-Faint resulting in pooling and that both intrahepatic resistance and splanchnic arterial vasoconstriction are reduced in Control-Faint resulting in increased splanchnic blood flow and reduced splanchnic resistance.
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Affiliation(s)
- Julian M. Stewart
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | - Mohamed A. Shaban
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | - Tyler Fialkoff
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | | | - Paul Visintainer
- Baystate Medical CenterUniversity of Massachusetts School of MedicineSpringfield 01199Massachusetts
| | - Courtney Terilli
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
| | - Marvin S. Medow
- Departments of Pediatrics and PhysiologyNew York Medical CollegeValhallaNew York
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Fedorowski A, Sutton R. Understanding vasovagal syncope akin to the philosopher's stone? J Cardiovasc Electrophysiol 2018; 30:297-298. [PMID: 30536536 DOI: 10.1111/jce.13810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Artur Fedorowski
- Department of Cardiology, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Richard Sutton
- Department of Cardiology, National Heart and Lung Institute, Imperial College, Hammersmith Hospital, London, UK
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Idiaquez J, Idiaquez JF, Iturriaga R. Cardiovascular responses to isometric handgrip exercise in young patients with recurrent vasovagal syncope. Auton Neurosci 2018; 212:23-27. [DOI: 10.1016/j.autneu.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/11/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
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Gopinathannair R, Salgado BC, Olshansky B. Pacing for Vasovagal Syncope. Arrhythm Electrophysiol Rev 2018; 7:95-102. [PMID: 29967681 PMCID: PMC6020179 DOI: 10.15420/aer.2018.22.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/03/2018] [Indexed: 12/28/2022] Open
Abstract
Vasovagal syncope (VVS) is due to a common autonomic reflex involving the cardiovascular system. It is associated with bradycardia (cardioinhibitory response) and/or hypotension (vasodepressor response), likely mediated by parasympathetic activation and sympathetic inhibition. While generally a situational, isolated and/or self-limited event, for some, VVS is recurrent, unpredictable and debilitating. Conservative, non-pharmacological management may help, but no specific medical therapy has been proven widely effective. Permanent pacing may have specific benefit, but its value has been debated. The temporal causative association of bradycardia with syncope in those with VVS may help identify which patient could benefit from pacing but the timing and type of pacing in lieu of blood pressure changes may be critical. The mode, rate, pacing algorithm and time to initiate dual-chamber pacing preferentially with respect to the vasovagal reflex may be important to prevent or ameliorate the faint but completely convincing data are not yet available. Based on available data, DDD pacing with the closed loop stimulation algorithm appears a viable, if not the best, alternative presently to prevent recurrent VVS episodes. While several knowledge gaps remain, permanent pacing appears to have a role in managing select patients with VVS.
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Affiliation(s)
| | - Benjamin C Salgado
- Division of Cardiovascular Medicine, University of LouisvilleLouisville, USA
| | - Brian Olshansky
- Mercy Heart and Vascular Institute, Mason City; and the University of Iowa HospitalsIowa City, USA
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Jardine DL, Wieling W, Brignole M, Lenders JWM, Sutton R, Stewart J. The pathophysiology of the vasovagal response. Heart Rhythm 2017; 15:921-929. [PMID: 29246828 DOI: 10.1016/j.hrthm.2017.12.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 10/18/2022]
Abstract
In part I of this study, we found that the classical studies on vasovagal syncope, conducted in fit young subjects, overstated vasodilatation as the dominant hypotensive mechanism. Since 1980, blood pressure and cardiac output have been measured continuously using noninvasive methods during tilt, mainly in patients with recurrent syncope, including women and the elderly. This has allowed us to analyze in more detail the complex sequence of hemodynamic changes leading up to syncope in the laboratory. All tilt-sensitive patients appear to progress through 4 phases: (1) early stabilization, (2) circulatory instability, (3) terminal hypotension, and (4) recovery. The physiology responsible for each phase is discussed. Although the order of phases is consistent, the time spent in each phase may vary. In teenagers and young adults, progressive hypotension during phases 2 and 3 can be driven by vasodilatation or falling cardiac output. The fall in cardiac output is secondary to a progressive decrease in stroke volume because blood is pooled in the splanchnic veins. In adults a fall in cardiac output is the dominant hypotensive mechanism because systemic vascular resistance always remains above baseline levels.
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Affiliation(s)
- David L Jardine
- Department of General Medicine, Christchurch Hospital, University of Otago, Christchurch, New Zealand.
| | - Wouter Wieling
- Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Michele Brignole
- Department of Cardiology, Arrhythmologic Centre, Ospedali del Tigullio, Lavagna, Italy
| | - Jacques W M Lenders
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Internal Medicine III, Technical University Dresden, Dresden, Germany
| | - Richard Sutton
- National Heart and Lung institute, Imperial College, London, United Kingdom
| | - Julian Stewart
- Departments of Pediatrics, Physiology, and Medicine, New York Medical College, Valhalla, New York
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Stewart JM, Sutton R, Kothari ML, Goetz AM, Visintainer P, Medow MS. Nitric oxide synthase inhibition restores orthostatic tolerance in young vasovagal syncope patients. Heart 2017; 103:1711-1718. [PMID: 28501796 DOI: 10.1136/heartjnl-2017-311161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Syncope is sudden transient loss of consciousness and postural tone with spontaneous recovery; the most common form is vasovagal syncope (VVS). We previously demonstrated impaired post-synaptic adrenergic responsiveness in young VVS patients was reversed by blocking nitric oxide synthase (NOS). We hypothesised that nitric oxide may account for reduced orthostatic tolerance in young recurrent VVS patients. METHODS We recorded haemodynamics in supine VVS and healthy volunteers (aged 15-27 years), challenged with graded lower body negative pressure (LBNP) (-15, -30, -45 mm Hg each for 5 min, then -60 mm Hg for a maximum of 50 min) with and without NOS inhibitor NG-monomethyl-L-arginine acetate (L-NMMA). Saline plus phenylephrine (Saline+PE) was used as volume and pressor control for L-NMMA. RESULTS Controls endured 25.9±4.0 min of LBNP during Saline+PE compared with 11.6±1.4 min for fainters (p<0.001). After L-NMMA, control subjects endured 24.8±3.2 min compared with 22.6±1.6 min for fainters. Mean arterial pressure decreased more in VVS patients during LBNP with Saline+PE (p<0.001) which was reversed by L-NMMA; cardiac output decreased similarly in controls and VVS patients and was unaffected by L-NMMA. Total peripheral resistance increased for controls but decreased for VVS during Saline+PE (p<0.001) but was similar following L-NMMA. Splanchnic vascular resistance increased during LBNP in controls, but decreased in VVS patients following Saline+PE which L-NMMA restored. CONCLUSIONS We conclude that arterial vasoconstriction is impaired in young VVS patients, which is corrected by NOS inhibition. The data suggest that both pre- and post-synaptic arterial vasoconstriction may be affected by nitric oxide.
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Affiliation(s)
- Julian M Stewart
- Departments of Pediatrics, New York Medical College, Valhalla, New York, USA.,Departments of Physiology, New York Medical College, Valhalla, New York, USA
| | - Richard Sutton
- The National Heart & Lung Institute, Imperial College, London, UK
| | - Mira L Kothari
- Departments of Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Amanda M Goetz
- Departments of Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Paul Visintainer
- Baystate Medical Center, University of Massachusetts School of Medicine 4, Springfield MA, USA
| | - Marvin Scott Medow
- Departments of Pediatrics, New York Medical College, Valhalla, New York, USA.,Departments of Physiology, New York Medical College, Valhalla, New York, USA
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Medow MS, Merchant S, Suggs M, Terilli C, O’Donnell-Smith B, Stewart JM. Postural Heart Rate Changes in Young Patients With Vasovagal Syncope. Pediatrics 2017; 139:peds.2016-3189. [PMID: 28351846 PMCID: PMC5369676 DOI: 10.1542/peds.2016-3189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recurrent postural vasovagal syncope (VVS) is caused by transient cerebral hypoperfusion from episodic hypotension and bradycardia; diagnosis is made by medical history. VVS contrasts with postural tachycardia syndrome (POTS), defined by chronic daily symptoms of orthostatic intolerance with excessive upright tachycardia without hypotension. POTS has recently been conflated with VVS when excessive tachycardia is succeeded by hypotension during tilt testing. We hypothesize that excessive tachycardia preceding hypotension and bradycardia is part of the vasovagal response during tilt testing of patients with VVS. METHODS We prospectively performed head-up tilt (HUT) testing on patients with recurrent VVS (n = 47, 17.9 ± 1.1 y), who fainted at least 3 times within the last year, and control subjects (n = 15, 17.1 ± 1.0 y), from age and BMI-matched volunteers and measured blood pressure, heart rate (HR), cardiac output, total peripheral resistance, and end tidal carbon dioxide. RESULTS Baseline parameters were the same in both groups. HR (supine versus 5 and 10 minutes HUT) significantly increased in control (65 ± 2.6 vs 83 ± 3.6 vs 85 ± 3.7, P < .001) and patients with VVS (69 ± 1.6 vs 103 ± 2.3 vs 109 ± 2.4, P < .001). HUT in controls maximally increased HR by 20.3 ± 2.9 beats per minute; the increase in patients with VVS of 39.8 ± 2.1 beats per minute was significantly greater (P < .001). An increase in HR of ≥40 beats per minute by 5 and 10 minutes or before faint with HUT, occurred in 26% and 44% of patients with VVS, respectively, but not in controls. CONCLUSIONS Orthostasis in VVS is accompanied by large increases in HR that should not be construed as POTS.
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Affiliation(s)
- Marvin S. Medow
- Departments of Pediatrics, and,Physiology, New York Medical College, Valhalla, New York
| | | | | | | | | | - Julian M. Stewart
- Departments of Pediatrics, and,Physiology, New York Medical College, Valhalla, New York
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Flevari P, Leftheriotis D, Kroupis C, Antonakos G, Lekakis J, Dima K. Copeptin levels in patients with vasovagal syncope. Int J Cardiol 2017; 230:642-645. [DOI: 10.1016/j.ijcard.2017.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/31/2016] [Accepted: 01/03/2017] [Indexed: 12/25/2022]
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