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Prof. Richard Sutton,
View the Slides from this session in ESC Congress 365
This session provided understanding of circulatory and neuroendocrine profile in Vasovagal syncope (VVS).
A Fedorowski, Malmo, Sweden reported about 671 patients from the SYSTEMA study. Consecutive patients had syncope presenting for investigation. Tilt-testing was combined with blood sampling in supine before and at 3 minutes of tilt. The data showed Endothelin-1, vasopressin, and epinephrine play prominent roles in orthostatic hypotension, while ANP and catecholamines are important in postural tachycardia. Thus, some dysautonomic syndromes share neuroendocrine disturbances.
A Pietrucha, Krakow, Poland presented a full review of the data on endothelial function in patients with syncope. Unfortunately, many studies have been of small groups and some results are conflicting. It is clear that endothelial function is important in syncope and that more and larger studies are needed.
G van Dijk, Leiden, Netherlands raised an important question: what is happening to the circulation and its control in the immediate period before vasovagal blood pressure fall? He had few answers, but this period may contain many clues to a more complete VVS understanding. A pointer was the revelation that in the period just afterwards but still before the major collapse cardioinhibition patients have much faster blood pressure fall than in vasodepressor syncope.
D Benditt, Minneapolis, MN, USA gave an overview of neuropeptides (NP) and catecholamines in syncope. A high epinephrine:norepinephrine ratio appears important and several NP are active in VVS. More is understood and yet more is necessary to be comprehended.
Innovations and understanding of vasovagal syncope
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