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The tilting cardiovascular response in orthostatic syncope

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Abstract

159 patients with a previous discharge diagnosis of recurrent vasodepressor syncope associated with prolonged standing or other circumstance known to trigger the condition were examined in order to isolate the orthostatic form. 72 patients with a history of at least two episodes of loss of consciousness after standing still for at least 10' were selected for testing by head-up tilt. Those who showed signs or symptoms during the test were tested a further twice, the third time after atropine administration. This process resulted in the diagnosis of orthostatic vasodepressor syncope in 28 patients who presented both 1) a positive test associated with hypotension and bradycardia and 2) bradycardia-free hypotention on repetition of the test with atropine.

Sommario

Abbiamo studiato 159 pazienti diagnosticati come affetti da sincope vasodepressiva associata a differenti condizioni ed in particolare anche alla prolungata stazione eretta. Fra questi ne selezionammo 72 che nell'anamnesi presentavano almeno due episodi di perdita di coscienza in ortostatismo. 71 soggetti, paragonabili per sesso ed età, costituirono il gruppo di controllo. I 143 pazienti così individuati furono sottoposti a tilting: quelli positivi lo ripeterono altre due volte, l'ultima con contemporanea somministrazione di atropina.

Questo iter diagnostico portò alla diagnosi di sincope ortostatica vasodepressiva in 28 soggetti che presentarono: 1) la positività del test associata a ipotensione e bradicardia, 2) una ipotensione senza bradicardia durante la ripetizione del test con atropina.

Infine fu possibile identificare due piccoli sottogruppi di pazienti che manifestarono durante il test asistolia (2 pazienti) e ipotensione associata a tachicardia (sincope simpatotonica, 3 casi) per i quali sono indicati provvedimenti terapeutici differenziati.

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Authors and Affiliations

  1. Divisione di Medicina Interna, Ospedale S. Maria Nuova, Via G. Mameli, 44 50131, Firenze

    Lagi A. & Vannucchi P. L.

  2. Clinica Neurologica, Università di Firenze, Via G. Mameli, 44 50131, Firenze

    Arnetoli G.

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  1. Lagi A.
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  2. Vannucchi P. L.
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  3. Arnetoli G.
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Lagi, A., Vannucchi, P.L. & Arnetoli, G. The tilting cardiovascular response in orthostatic syncope. Ital J Neuro Sci 13, 203–207 (1992). https://doi.org/10.1007/BF02224390

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