Background: The links between circulatory pathophysiology and clinical expressions
of reflex syncope are imperfectly known. Aim: To improve knowledge of these links.
Methods: By adding video-EEG recording to tilt-table-testing (TTT) we recorded clinical,
circulatory and EEG changes at a one-second resolution. Results: We explored 69 cases
with complete records of tilt-induced syncope. The two EEG patterns, slow (S) or slow-flat-slow
(SFS), represented moderate and profound cerebral hypoperfusion. The S and SFS patterns
are associated with four types of signs and symptoms. One starts and ends during slowing,
e.g. loss of consciousness (LOC). One occurs during slowing only, implicating some
degree of cortical activity, such as myoclonic jerks. One occurs during flattening
only, such as roving eye movements and stertorous breathing. Finally, one occurred
regardless of the EEG phase. Although the SFS pattern has been associated with asystole
it could occur without asystole, without an appreciably lower mean arterial pressure
(MAP) than when it did not. The point in time when pacemakers conventionally start,
three seconds since the last heart beat, were compared with the timing of clinical
LOC. In 6 of 22 asystolic cases without nitroglycerin, asystole occurred after LOC
(27%). Conclusions: Some clinical signs help identify severe hypoperfusion due to
arrhythmia or cardioinhibitory reflex syncope. Unidentified factors other than MAP
and heart rate must influence the degree of cerebral hypoperfusion. The time of asystole
must be compared to that of LOC when decisions are made concerning pacing in reflex
syncope.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Autonomic Neuroscience: Basic and ClinicalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Identification
Copyright
© 2015 Published by Elsevier Inc.