Skip to main content

Advertisement

SpringerLink
Log in

Typical vasovagal syncope as a “defense mechanism” for the heart by contrasting sympathetic overactivity

  • Review
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Many observations suggest that typical (emotional or orthostatic) vasovagal syncope (VVS) is not a disease, but rather a manifestation of a non-pathological trait. Some authors have hypothesized this type of syncope as a “defense mechanism” for the organism and a few theories have been postulated. Under the human violent conflicts theory, the VVS evolved during the Paleolithic era only in the human lineage. In this evolutionary period, a predominant cause of death was wounding by a sharp object. This theory could explain the occurrence of emotional VVS, but not of the orthostatic one. The clot production theory suggests that the vasovagal reflex is a defense mechanism against hemorrhage in mammals. This theory could explain orthostatic VVS, but not emotional VVS. The brain self-preservation theory is mainly based on the observation that during tilt testing a decrease in cerebral blood flow often precedes the drop in blood pressure and heart rate. The faint causes the body to take on a gravitationally neutral position, and thereby provides a better chance of restoring brain blood supply. However, a decrease in cerebral blood flow has not been demonstrated during negative emotions, which trigger emotional VVS. Under the heart defense theory, the vasovagal reflex seems to be a protective mechanism against sympathetic overactivity and the heart is the most vulnerable organ during this condition. This appears to be the only unifying theory able to explain the occurrence of the vasovagal reflex and its associated selective advantage, during both orthostatic and emotional stress.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Accurso V, Winnicki M, Shamsuzzmam ASM, Wenzel A, Johnson AK, Somers VK (2001) Predisposition to vasovagal syncope in subjects with blood/injury phobia. Circulation 104:903–907

    Article  CAS  PubMed  Google Scholar 

  2. Adams DB, Baccelli G, Mancia G, Zanchetti A (1968) Cardiovascular changes during preparation for fighting behaviour in the cat. Nature 220:1239–1240

    Article  CAS  PubMed  Google Scholar 

  3. Alboni P, Alboni M, Bertorelle G (2008) The origin of vasovagal syncope: to protect the heart or to escape predation? Clin Auton Res 18:170–178

    Article  PubMed  Google Scholar 

  4. Alboni P, Bondanelli M, Dinelli M, Gruppillo P, Franceschetti P, Marchi P et al (2000) Role of the serotoninergic system in the genesis of vasovagal syncope. Europace 2:172–180

    Article  CAS  PubMed  Google Scholar 

  5. Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M et al (2001) Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 37:1921–1928

    Article  CAS  PubMed  Google Scholar 

  6. Alboni P, Brignole M, Degli Uberti EC (2007) Is vasovagal syncope a disease? Europace 9:83–87

    Article  PubMed  Google Scholar 

  7. Ayala ES, Meuret AE, Ritz T (2010) Confrontation with blood and disgust stimuli precipitates respiratory dysregulation in blood-injection-injury phobia. Biol Psychol 84:88–97

    Article  PubMed  Google Scholar 

  8. Bishop CC, Powell S, Rutt D, Browse NL (1986) Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke 17:913–915

    Article  CAS  PubMed  Google Scholar 

  9. Blanc JJ, Benditt DG (2016) Vasovagal syncope: hypothesis focusing on its being a clinical feature unique to humans. J Cardiovasc Electrophysiol 27:623–629

    Article  PubMed  Google Scholar 

  10. Bondar RL, Kassam MS, Stein F, Dunphy PT, Fortney S, Riedesel L (1995) Simultaneous cerebrovascular and cardiovascular responses during presyncope. Stroke 26:1794–1800

    Article  CAS  PubMed  Google Scholar 

  11. Bracha HS, Bracha AS, Williams AE, Ralston TC, Matsukawa JM (2005) The human fear-circuitry and fear-induced fainting in healthy individuals. The paleolithic-threat hypothesis. Clin Auton Res 15:238–241

    Article  PubMed  Google Scholar 

  12. Brignole M, Menozzi C, Gianfranchi L, Oddone D, Lolli G, Bertulla A (1991) Carotid sinus massage, eyeball compression and head-up tilt test in patients with syncope of uncertain origin and in healthy control subjects. Am Heart J 122:1644–1651

    Article  CAS  PubMed  Google Scholar 

  13. Burke SL, Dorward PK (1988) Influence of endogenous opiates and cardiac afferents on renal nerve activity during haemorrhage in conscious rabbits. J Physiol Lond 402:9–27

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Chalmers JP, Corner PI, White SW (1967) Effects of hemorrhage on the distribution of blood flow in the rabbit. J Physiol Lond 192:561–574

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Cheng R, Shang Y, Wang S, Evans JM, Rayapati A, Randall DC et al (2014) Near-infrared diffuse optical monitoring of cerebral blood flow and oxygenation for the prediction of vasovagal syncope. J Biomed Opt 19:017001

    Article  PubMed Central  Google Scholar 

  16. Colman N, Nahm K, Ganzeboom KS, Shen WK, Reitsma JB, Linzer M et al (2004) Epidemiology of reflex syncope. Clin Auton Res 14:9–17

    Article  PubMed  Google Scholar 

  17. Dan D, Hoag JB, Ellenbogen KA, Wood MA, Eckberg DL, Gilligan DM (2002) Cerebral blood flow velocity declines before arterial pressure in patients with orthostatic vasovagal presyncope. J Am Coll Cardiol 39:1039–1045

    Article  PubMed  Google Scholar 

  18. Darwin C (1900) A posthumous essay on instinct. In: Romanes GJ (ed) Mental evolution in animals. Appleton, New York

    Google Scholar 

  19. Dermkasian G, Lamb RE (1958) Syncope in a population of healthy young adults. Incidence, mechanisms and significance. JAMA 68:1200–1207

    Article  Google Scholar 

  20. Diehl RR (2005) Vasovagal syncope and Darwinian fitness. Clin Auton Res 15:126–129

    Article  PubMed  Google Scholar 

  21. Dorward PK, Riedel KW, Burke J, Gipps J, Korner PI (1985) The renal sympathetic baroreflex in the rabbit: arterial and cardiac baroceptor influences, resetting, and effect of anesthesia. Circ Res 57:618–633

    Article  CAS  PubMed  Google Scholar 

  22. Engel GL (1978) Psychologic stress, vasodepressor (vasovagal) syncope, and sudden death. Ann Intern Med 89:403–412

    Article  CAS  PubMed  Google Scholar 

  23. Engel GL, Romano J (1947) Studies of syncope. IV. Biologic interpretation of vasodepressor syncope. Psychosom Med 9:288–294

    Article  CAS  PubMed  Google Scholar 

  24. Espmark Y, Langvatn R (1979) Cardiac responses in alarmed red deer calves. Behav Process 4:179–186

    Article  CAS  Google Scholar 

  25. Forsyth RP, Hoffbrand BI, Melmon KL (1970) Redistribution of cardiac output during hemorrhage in the unanesthetized monkey. Circ Res 27:311–320

    Article  CAS  PubMed  Google Scholar 

  26. Gabrielsen G, Kanwisher JW, Steen JB (1977) “Emotional” bradycardia: a telemetry study on incubating willow grouse (Lagopus lagopus). Acta Physiol Scand 100:255–257

    Article  CAS  PubMed  Google Scholar 

  27. Gabrielsen GW, Smith EN (1985) Physiological responses associated with feigned death in the American opossum. Acta Physiol Scand 123:393–398

    Article  CAS  PubMed  Google Scholar 

  28. Gallup GG Jr (1974) Animal hypnosis: factual status of a fictional concept. Psycho Bull 81:836–853

    Article  Google Scholar 

  29. Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W (2003) Prevalence and triggers of syncope in medical students. Am J Cardiol 91:1006–1008

    Article  PubMed  Google Scholar 

  30. Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, Wieling W, van Dijk N (2006) Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35–60 years. J Cardiovasc Electrophysiol 17:1172–1176

    Article  PubMed  Google Scholar 

  31. Gaunt AS, Gans C (1969) Diving bradycardia and withdrawal bradycardia in caiman crocodilus. Nature 223:207–208

    Article  CAS  PubMed  Google Scholar 

  32. Goodman DA, Weinberger NM (1970) Possible relationship between orienting and diving reflexes. Nature 225:1153–1155

    Article  CAS  PubMed  Google Scholar 

  33. Graham DT, Kabler JD, Lunsford L (1961) Vasovagal fainting: a diphasic response. Psychosom Med 23:493–507

    Article  CAS  PubMed  Google Scholar 

  34. Grubb BP (1998) Dysautonomic (orthostatic) syncope. In: Grubb BP, Olshansky B (eds) Syncope: mechanisms and management. Futura, Armonk, pp 73–106

    Google Scholar 

  35. Hoagland H (1928) On the mechanism of tonic immobility (“animal hypnosis”). J Gen Physiology 1:426–477

    Google Scholar 

  36. Hofer MA (1970) Cardiac and respiratory function during sudden prolonged immobility in wild rodents. Phychosom Med 32:633–647

    Article  CAS  Google Scholar 

  37. Jacobsen NK (1979) Alarm bradycardia in white-tailed deer fawns (Odocoileus virginianus). J Mammal 60:343–349

    Article  Google Scholar 

  38. Jardine DL, Melton IC, Crozier JG, English S, Bennet SI, Frampton CA et al (2002) Decrease in cardiac output and muscle sympathetic activity during vasovagal syncope. Am J Physiol Heart Circ Physiol 282:H1804–H1809

    Article  CAS  PubMed  Google Scholar 

  39. Kanwisher JK, Lawson K, Sundnes G (1974) Acoustic telemetry from fish. Fish Bull 72:251–255

    Google Scholar 

  40. Kenny RA, Neil E (1951) The contribution of aortic chemoreceptor mechanisms to the maintenance of arterial blood pressure of cats and dogs after hemorrhage. J Physiol Lond 112:223–228

    Article  Google Scholar 

  41. Klemm WR (1971) Neurophysiologic studies of the immobility reflex (“animal hypnosis”). Neurosci Res 4:165–212

    Article  CAS  PubMed  Google Scholar 

  42. Lamb LE, Green HC, Combs JJ, Cheeseman SA, Hammond J (1960) Incidence of loss of consciousness in 1980 air force personnel. Aerosp Med 31:973–988

    CAS  PubMed  Google Scholar 

  43. Lipsitz LA, Hayano J, Sakata S, Okada A, Morin RJ (1998) Complex demodulation of cardiorespiratory dynamics preceding vasovagal syncope. Circulation 98:977–983

    Article  CAS  PubMed  Google Scholar 

  44. Lupo M, Troisi E, Chiricozzi FR, Clausi S, Molinari M, Leggio M (2015) Inability to process negative emotions in cerebellar damage: a functional transcranial Doppler sonographic study. Cerebellum 14:663–669

    Article  PubMed  Google Scholar 

  45. McIntosh SJ, Lawson J, Kenny RA (1993) Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly. Am J Med 95:203–208

    Article  CAS  PubMed  Google Scholar 

  46. Morgan DA, Thoren P, Wilczysnsky EA, Victor RG, Mark AL (1988) Serotonergic mechanisms mediate moderate renal sympathoinhibition during severe hemorrhage in rats. Am J Physiol 255:H496–H502

    CAS  PubMed  Google Scholar 

  47. Morita H, Nishida Y, Motochigawa H, Uemura N, Hosomi H, Vatner SF (1988) Opiate receptor-mediated decrease in renal nerve activity during hypotensive hemorrhage in conscious rabbits. Circ Res 63:165–172

    Article  CAS  PubMed  Google Scholar 

  48. Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB et al (2009) Guidelines for the diagnosis and management of syncope (version 2009). The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Developed in collaboration with European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS). Eur Heart J 30:2631–2671

    Article  PubMed  PubMed Central  Google Scholar 

  49. Murdoch BD (1980) Loss of consciousness in healthy South African men: incidence, causes and relationship to ECG abnormality. S Afr Med J 57:771–774

    CAS  PubMed  Google Scholar 

  50. Njemanze PC (1992) Clinical limits of pressure-flow relation in the human brain. Stroke 23:1743–1747

    Article  CAS  PubMed  Google Scholar 

  51. O’Dwyer C, Bennett K, Langan J, Fan CW, Kenny RA (2011) Amnesia for loss of consciousness is common in vasovagal syncope. Europace 13:1040–1045

    Article  PubMed  Google Scholar 

  52. Page AC (1994) Blood-injury phobia. Clin Psychol Rev 14:443–461

    Article  Google Scholar 

  53. Porteiro Vázquez DM, Perego M, Santos L, Gerou-Ferriani M, Martin MWS, Santilli RA (2016) Paroxismal atrial fibrillation in seven dogs with presumed neurally-mediated syncope. J Vet Cardiol 18:1–9

    Article  PubMed  Google Scholar 

  54. Providencia R, Silva J, Mota P, Nascimento J, Leitao-Marques A (2011) Transient loss of consciousness in young adults. Int J Cardiol 152:139–143

    Article  PubMed  Google Scholar 

  55. Rihs F, Sturzenegger M, Gutbrod K, Schroth G, Mattle HP (1999) Determination of language dominance: Wada test confirms functional transcranial Doppler sonography. Neurology 52:1591–1596

    Article  CAS  PubMed  Google Scholar 

  56. Ritz T, Meuret AE, Ayala ES (2010) The psychophysiology of blood-injection-injury phobia: looking beyond the diphasic response paradigm. Int J Psychophysiol 78:50–67

    Article  PubMed  Google Scholar 

  57. Roberts I, Evans P, Bunn F, Kwan I, Crowhurst E (2001) Is the normalization of blood pressure in bleeding trauma patients harmful? Lancet 357:385–387

    Article  CAS  PubMed  Google Scholar 

  58. Sander-Jensen K, Secher NH, Bie P, Warberg J, Schwartz TW (1986) Vagal slowing of the heart during hemorrhage: observations from 20 consecutive hypotensive patients. Br Med J 292:364–366

    Article  CAS  Google Scholar 

  59. Schadt JC, Gaddis RR (1985) Endogenous opiate peptides may limit norepinephrine release during hemorrhage. J Pharmacol Exp Ther 232:656–660

    CAS  PubMed  Google Scholar 

  60. Schadt JC, Ludbrook AJ (1991) Hemodynamic and neurohumoral responses to acute hypovolemia in conscious mammals. Am J Physiol Heart Circ Physiol 260:H305–H318

    CAS  Google Scholar 

  61. Sergeant AB, Eberhardt LE (1975) Death feigning by ducks in response to predation by red foxes (Vulpes fulva). Am Midl Nat 94:108–119

    Article  Google Scholar 

  62. Serletis A, Rose S, Sheldon AG, Sheldon RS (2006) Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J 27:1965–1970

    Article  PubMed  Google Scholar 

  63. Sheldon RS, Sheldon AG, Connolly SJ, Morillo CA, Klingenheben T, Krahan AD et al (2006) Age of first faint in patients with vasovagal syncope. J Cardiovasc Electrophysiol 17:49–54

    Article  PubMed  Google Scholar 

  64. Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD et al (2017) 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope. A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines, and the Heart Rhythm Society. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.03.003

    Google Scholar 

  65. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ et al (2002) N Engl J Med 347:878–885

    Article  PubMed  Google Scholar 

  66. Szufladowicz E, Maniewski R, Kozluk E, Zbiec A, Nosek A, Walczak F (2004) Near-infrared spectroscopy in evaluation of cerebral oxygenation during vasovagal syncope. Physiol Meas 25:823–836

    Article  CAS  PubMed  Google Scholar 

  67. Troisi E, Silvestrini M, Matteis M, Monaldo BC, Vernieri F, Caltagirone C (1999) Emotion-related cerebral asymmetry: hemodynamics measured by functional ultrasound. J Neurol 246:1172–1176

    Article  CAS  PubMed  Google Scholar 

  68. Troisi E, Peppe A, Pierantozzi M, Matteis M, Vernieri F, Stanzione P et al (2002) Emotional processing in Parkinson’s disease. A study using functional transcranial Doppler sonography. J Neurol 249:993–1000

    Article  CAS  PubMed  Google Scholar 

  69. Vaddadi G, Esler MD, Dawood T, Lambert E (2010) Persistence of muscle sympathetic nerve activity during vasovagal syncope. Eur Heart J 31:2027–2033

    Article  PubMed  Google Scholar 

  70. van Dijk JG (2003) Fainting in animals. Clin Auton Res 13:247–255

    Article  PubMed  Google Scholar 

  71. van Dijk JG, Sheldon R (2008) Is there any point to vasovagal syncope? Clin Auton Res 18:167–169

    Article  PubMed  Google Scholar 

  72. Victor RG, Thoren P, Morgan DA, Mark AL (1989) Differential control of adrenal and renal sympathetic nerve activity during hemorrhagic hypotension in rats. Circ Res 64:686–694

    Article  CAS  PubMed  Google Scholar 

  73. Wallin BG, Sundlöf G (1982) Sympathetic outflow to muscle during vasovagal syncope. J Auton Nerv Syst 6:287–291

    Article  CAS  PubMed  Google Scholar 

  74. Waxman MB, Asta JA, Cameron DA (1992) Localization of the reflex pathway responsible for the vasodepressor reaction induced by inferior vena cava occlusion and isoproterenol. Can J Physiol Pharmacol 70:882–889

    Article  CAS  PubMed  Google Scholar 

  75. Wisbach G, Tobias S, Woodman R, Spalding A, Lockette W (2007) Preserving cardiac output with beta-adrenergic receptor blockade and inhibiting the Bezold-Jarisch reflex during resuscitation from hemorrhage. J Trauma 63:26–32

    Article  PubMed  Google Scholar 

  76. Zhang HL, Guo ZN, Yang G, Yang L, Han K, Wu J et al (2012) Compromised cerebrovascular modulation in chronic anxiety: evidence from cerebral blood flow velocity measured by transcranial Doppler sonography. Neurosci Bull 28:723–728

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Cardiology and Syncope Unit, Ospedale Privato Quisisana, Viale Cavour 128, 44121, Ferrara, Italy

    Paolo Alboni

  2. Department of Zoology and Anthropology, University of Sassari, Sassari, Italy

    Marco Alboni

Authors
  1. Paolo Alboni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Alboni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Alboni.

Ethics declarations

Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Funding

No funding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alboni, P., Alboni, M. Typical vasovagal syncope as a “defense mechanism” for the heart by contrasting sympathetic overactivity. Clin Auton Res 27, 253–261 (2017). https://doi.org/10.1007/s10286-017-0446-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10286-017-0446-2

Keywords

Search

Navigation