Vasovagal Syncope – ABC CARDIOL

IJCS

Editorial

Assessment of Quality of Life after Diagnosis of Reflex Syncope: A Subjective Outcome of Great Clinical Importance with Multifactorial Cause

Nágela Nunes et al. Alfredo de Souza Bomfim

Syncope, a clinical syndrome characterized by transient loss of consciousness (TLOC), is defined by specific elements, namely: sudden onset and rapid recovery, loss of postural tone, full recovery of consciousness, amnesia of the event, nonresponsiveness, and a typical event duration of up to 5 minutes (usually lasting seconds). The pathophysiology of syncope involves global cerebral hypoperfusion, primarily due to a drop in blood pressure (BP), with various factors contributing individually or in combination to syncope (). Even brief periods of cessation of cerebral blood flow (6–8 s) or a systolic BP of 50–60 mmHg at the level of the heart (equivalent to 30–45 mmHg at the level of the brain in the upright position) can lead to TLOC. Pathophysiological mechanisms may include a decrease in peripheral vascular resistance, cardiac output, or a decrease in both. The etiology of syncope is didactically classified into three types: 1) orthostatic hypotension (OH); 2) reflex syncope (also termed vasovagal or neurally mediated syncope); and 3) cardiac syncope.

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Original Article

Comparison between tilt-table testing results performed during different periods of the day

Tan Chen Wu et al. Denise Hachul Mauricio Scanavacca Eduardo Sosa

OBJECTIVE: To evaluate the influences of circadian variations on tilt-table testing (TTT) results by comparing the positivity rate of the test performed during the morning with that of the test performed in the afternoon and to evaluate the reproducibility of the results in different periods of the day. METHODS: One hundred twenty-three patients with recurrent unexplained syncope or near-syncope referred for TTT were randomized into 2 groups. In group I, 68 patients, TTT was performed first in the afternoon and then in the morning. In group II, 55 patients, the test was performed first in the morning and then in the afternoon. RESULTS: The TTT protocol was the prolonged passive test, without drug sensitization. Twenty-nine (23.5%) patients had a positive result in at least one of the periods. The positivity rate for each period was similar: 20 (16.2%) patients in the afternoon and 19 (15.4%) in the morning (p=1.000). Total reproducibility (positive/positive and negative/negative) was observed in 49 (89%) patients in group I and in 55 (81%) in group II. Reproducibility of the results was obtained in 94 (90.4%) patients with first negative tests but in 10 (34%) patients with first positive tests. CONCLUSION: TTT could be performed during any period of the day, and even in the 2 periods to enhance positivity. Considering the low reproducibility rate of the positive tests, serial TTT to evaluate therapeutic efficacy should be performed during the same period of the day.

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Assessment of Quality of Life after Diagnosis of Reflex Syncope: A Subjective Outcome of Great Clinical Importance with Multifactorial Cause

Comparison between tilt-table testing results performed during different periods of the day

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