SÍNCOPE NEUROCARDIOGÉNICO, A PROPÓSITO DE UN CASO

Roberto A. Ferro Valdés

Submitted October 21, 2024

Published 2026-04-06

Artículos de Investigación

Vol. 18 No. 2 (2005): Revista Médico Científica

NEUROCARDIOGENIC SYNCOPE, ON PURPOSE OF A CASE

Roberto A. Ferro Valdés⁺⁻

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Published: 2026-04-06

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Abstract

The neurocardiogenic syncope or neurally mediated hypotension or, vasodepressor and vasovagal syncope, have been used to describe a common abnormality of blood pressure regulation characterized by a sudden appearance of hypotension with or without bradycardia. Loss of consciousness results from a decrease of blood flow to the reticular activating system, which is exquisitely dependent on perfusion .

We are presenting a case of a 34-years-old patient who experienced loss of consciousness while eating.The clinical history and the complete physical exam, plus an EKG and an electroencephalogram provided us with enough evidence to make a neurocardiogenic syncope diagnosis. Afterwards a bibliographic review and a deep discussion of the case were presented.

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References

Brígnole M, Alboni P, Benditt O, Bergfeldt L, Blanc JJ, Bloch PE et al. Task Force on Syncope, European Society of Cardiology: Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001;22:1256-306.
Ammirati F, Colivicchi F, Santini M: Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicenter prospective trial – The OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J 2000;21:935-40.
Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M et al: Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001;27:1921-8.
Sarasin FP, Louis-Simonet M, Carballo O, Slama S, Rajeswaran A, Metzger JT et al: Prospective evaluation of patients with syncope: A population-based study. Am J Med 2001;111:177-84.
Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L et al. Incidence and prognosis of syncope. N Engl J Med 2002;347:878-85.
Nyman JA, Krahn AD, Bland PC, Griffiths S, Manda V. The costs of recurrent syncope of unknown origin in elderly patients. Pacing Clin Electrophysiol 1999;22:1386-94.
Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Brooks WB. Impairment of physical and psychosocial function in recurrent syncope. J Clin Epidemiol 1991;44:1037-43.
Grubb BP, Karas B. Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: an overview of classification, clinical evaluation, and management. Pacing Clin Electrophysiol 1999;22:798-810.
Wieling W, van Lieshout J. Maintenance of postural normotension in humans. In: Low PA, ed. Clinical autonomic disorders: evaluation and management. 2nd ed. Philadelphia: Lippincott-Raven, 73-9, 1997.
Shepherd RFJ, Sheperd JT. Control of the blood pressure and the circulation in man. In: Mathias CJ, Bannister R, eds. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. 4th ed. Oxford, England: Oxford University Press, 72-5, 1999.
The Consensus Committee of the American Autonomic Society and the American Academy of Neurology: Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996;46:1470.
Morillo CA, Camacho ME, Wood MA, Gilligan DM, Ellenbogen KA. Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope. J Am Coll Cardiol 1999;34:1587-94.
Kosinski D, Grubb BP, Temesy-Armos P. Pathophysiological aspects of neurocardiogenic syncope: current concepts and new perspectives. Pacing Clin Electrophysiol 1995;18:16-24.
Mosqueda-García R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation 2000;102:2898-906.
Lurie KG, Benditt D. Syncope and the autonomic nervous system. J Cardiovasc Electrophysiol 1996;7:760-76.
Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA et al: Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol 2002;40:142-8.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Ann Intern Med 1997;126:989-96.
Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 2: Unexplained syncope. Ann Intern Med 1997;127:76-86.
Link MS, Lauer EP, Homoud MK, Wang PJ, Estes NA 3rd. Low yield of rule-out myocardial infarction protocol in patients presenting with syncope. Am J Cardiol 2001;88:706-7.
Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB. Tilt table testing for assessing syncope. J Am Coll Cardiol 1996;28:263-75.
Takase B, Uehata A, Nishioka T, Isojima K, Satomura K, Ohsuzu F et al: Different mechanisms of isoproterenol-induced and nitroglycerin-induced syncope during head-up tilt in patients with unexplained syncope: Important role of epinephrine in nitroglycerin-induced syncope. J Cardiovasc Electrophysiol 2001;12:791-6.
Di Girolamo E, Di Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor on refractory vasovagal syncope: A randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999;33:1227-30.

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[1] Brígnole M, Alboni P, Benditt O, Bergfeldt L, Blanc JJ, Bloch PE et al. Task Force on Syncope, European Society of Cardiology: Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J 2001;22:1256-306.

[2] Ammirati F, Colivicchi F, Santini M: Diagnosing syncope in clinical practice. Implementation of a simplified diagnostic algorithm in a multicenter prospective trial – The OESIL 2 study (Osservatorio Epidemiologico della Sincope nel Lazio). Eur Heart J 2000;21:935-40.

[3] Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M et al: Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 2001;27:1921-8.

[4] Sarasin FP, Louis-Simonet M, Carballo O, Slama S, Rajeswaran A, Metzger JT et al: Prospective evaluation of patients with syncope: A population-based study. Am J Med 2001;111:177-84.

[5] Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L et al. Incidence and prognosis of syncope. N Engl J Med 2002;347:878-85.

[6] Nyman JA, Krahn AD, Bland PC, Griffiths S, Manda V. The costs of recurrent syncope of unknown origin in elderly patients. Pacing Clin Electrophysiol 1999;22:1386-94.

[7] Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Brooks WB. Impairment of physical and psychosocial function in recurrent syncope. J Clin Epidemiol 1991;44:1037-43.

[8] Grubb BP, Karas B. Clinical disorders of the autonomic nervous system associated with orthostatic intolerance: an overview of classification, clinical evaluation, and management. Pacing Clin Electrophysiol 1999;22:798-810.

[9] Wieling W, van Lieshout J. Maintenance of postural normotension in humans. In: Low PA, ed. Clinical autonomic disorders: evaluation and management. 2nd ed. Philadelphia: Lippincott-Raven, 73-9, 1997.

[10] Shepherd RFJ, Sheperd JT. Control of the blood pressure and the circulation in man. In: Mathias CJ, Bannister R, eds. Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. 4th ed. Oxford, England: Oxford University Press, 72-5, 1999.

[11] The Consensus Committee of the American Autonomic Society and the American Academy of Neurology: Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996;46:1470.

[12] Morillo CA, Camacho ME, Wood MA, Gilligan DM, Ellenbogen KA. Diagnostic utility of mechanical, pharmacological and orthostatic stimulation of the carotid sinus in patients with unexplained syncope. J Am Coll Cardiol 1999;34:1587-94.

[13] Kosinski D, Grubb BP, Temesy-Armos P. Pathophysiological aspects of neurocardiogenic syncope: current concepts and new perspectives. Pacing Clin Electrophysiol 1995;18:16-24.

[14] Mosqueda-García R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation 2000;102:2898-906.

[15] Lurie KG, Benditt D. Syncope and the autonomic nervous system. J Cardiovasc Electrophysiol 1996;7:760-76.

[16] Sheldon R, Rose S, Ritchie D, Connolly SJ, Koshman ML, Lee MA et al: Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol 2002;40:142-8.

[17] Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 1: Value of history, physical examination, and electrocardiography. Ann Intern Med 1997;126:989-96.

[18] Linzer M, Yang EH, Estes NA 3rd, Wang P, Vorperian VR, Kapoor WN. Diagnosing syncope. Part 2: Unexplained syncope. Ann Intern Med 1997;127:76-86.

[19] Link MS, Lauer EP, Homoud MK, Wang PJ, Estes NA 3rd. Low yield of rule-out myocardial infarction protocol in patients presenting with syncope. Am J Cardiol 2001;88:706-7.

[20] Benditt DG, Ferguson DW, Grubb BP, Kapoor WN, Kugler J, Lerman BB. Tilt table testing for assessing syncope. J Am Coll Cardiol 1996;28:263-75.

[21] Takase B, Uehata A, Nishioka T, Isojima K, Satomura K, Ohsuzu F et al: Different mechanisms of isoproterenol-induced and nitroglycerin-induced syncope during head-up tilt in patients with unexplained syncope: Important role of epinephrine in nitroglycerin-induced syncope. J Cardiovasc Electrophysiol 2001;12:791-6.

[22] Di Girolamo E, Di Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor on refractory vasovagal syncope: A randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999;33:1227-30.

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