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Recurrent Supine Syncope:
Author(s) -
ISKOS DEMOSTHENES,
SHULTZ JEFFREY J.,
BENDITT DAVID G.
Publication year - 1998
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1998.tb00932.x
Subject(s) - presyncope , medicine , supine position , syncope (phonology) , tilt table test , vasovagal syncope , disopyramide , bradycardia , cardiology , anesthesia , heart rate , blood pressure
Supine Syncope. Introduction : Syncope occasionally may occur in the supine patient due to severe brady‐ or tachyarrhythmia. However, recurrent syncope upon assumption of the supine position as a result of a neurally mediated reflex mechanism has not been reported previously. Methods and Results : Two young patients, both of whom had significant systemic illnesses, experienced recurrent episodes of presyncope and/or syncope shortly after assuming the supine position. During ambulatory ECG monitoring, symptoms were provoked only by lying down and were associated with transient bradycardia. Head‐up tilt table testing was undertaken as part of the syncope evaluation and was nondiagnostic in both cases. However, both patients exhibited a transient cardioinhibitory response with reproduction of typical symptoms upon return of the table to the supine position (“reverse tilt”). During follow‐up (8 and 14 months), both patients improved with pharmacologic treatment (disopyramide in one case and midodrine in the other). Conclusion : Presyncope or syncope upon lying down can he an unusual manifestation of the neurally mediated faint.