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Titolo:
Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope
Autore:
Morillo, CA; Camacho, ME; Wood, MA; Gilligan, DM; Ellenbogen, KA;
Indirizzi:
Virginia Commonwealth Univ, Med Coll Virginia, Dept Med, Richmond, VA 23284 USA Virginia Commonwealth Univ Richmond VA USA 23284 , Richmond, VA 23284 USA Hunter Holmes Mc Guire Vet Affairs Med Ctr, Richmond, VA USA Hunter HolmesMc Guire Vet Affairs Med Ctr Richmond VA USA hmond, VA USA Fdn Cardiovasc Oriente Colombiano, Dept Cardiol, Bucaramanga, Colombia FdnCardiovasc Oriente Colombiano Bucaramanga Colombia amanga, Colombia
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
fascicolo: 5, volume: 34, anno: 1999,
pagine: 1587 - 1594
SICI:
0735-1097(19991101)34:5<1587:DUOMPA>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
SUSTAINED VENTRICULAR-TACHYCARDIA; ELDERLY PATIENTS; CLINICAL CHARACTERISTICS; BAROREFLEX SENSITIVITY; HYPERSENSITIVITY; VASODEPRESSOR; REFLEX; VAGAL; TILT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Morillo, CA Colombiano Inst Corazon, Fdn Cardiovasc Oriente, Dept Cardiol & CardiovascSci, Calle 155A,23-58, Floridablanca, Santander, Colombia Colombiano Inst Corazon Calle 155A,23-58 Floridablanca Santander Colombia
Citazione:
C.A. Morillo et al., "Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope", J AM COL C, 34(5), 1999, pp. 1587-1594

Abstract

OBJECTIVES The purpose of the present study was to systematically evaluatethe diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in a consecutive series of patients with recurrent unexplained syncope. BACKGROUND Carotid sinus hypersensitivity (CSH) is an infrequently recognized cause of recurrent unexplained syncope usually diagnosed by carotid sinus massage (CSM) in the supine position. The diagnostic utility of systematic assessment of mechanical, pharmacological and orthostatic stimulation ofthe carotid sinus has not been clearly established. METHODS Eighty consecutive patients (63 +/- 12 years) with a history of recurrent unexplained syncope (mean episodes: 6 +/- 3); 30 age-matched controls (65 +/- 14 years) and 16 patients (59 +/- 12 years) with syncope not related to CSH were studied. Pharmacological stimulation of the carotid sinus was achieved by randomly administering bolus injections of nitroprusside and phenylephrine. Mechanical stimulation of the carotid sinus was performed by CSM applied for 5 s in the supine position and after 2 min at 60 degrees. A 60 degrees low-dose isoproterenol head-up tilt test (HUTT) was also performed for a total duration of 30 min. RESULTS Carotid sinus hypersensitivity was elicited by CSM in the supine position in seven (8.7%) patients, two (6.6%) controls and one (6.3%) patient with syncope unrelated to CSH, compared with 48 (60%) patients, two (6.6%) controls and one (6.3%) syncope unrelated to CSH patient after 60 degreesHUTT, increasing the diagnostic yield by 51%. Baroreceptor gain was significantly reduced in the CSH group. Head-up tilt test was positive in 12 (25%) patients with CSH, two (6.6%) controls and two (12%) with documented syncope but not positive in any of the patients in which syncope remained unexplained. Diagnostic accuracy was enhanced by 38% (31% supine vs. 69% upright) when CSM was performed at 60 degrees. CONCLUSIONS CSH was documented in 68% of patients, 8.7% in the supine position and 60% in the upright position. Sensitivity was increased by 51%, anddiagnostic accuracy was enhanced by 38% by performing CSM in the upright position. Decreased baroreceptor gain nas documented and may play a role in the pathophysiology of CSH. (C) 1999 by the American College of Cardiology.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/11/20 alle ore 03:32:41