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{{Neurocardiogenic syncope}}
{{Neurocardiogenic syncope}}
{{CMG}}
{{CMG}}; {{AOEIC}} {{LG}}


==Overview==
==Overview==
[[Neurocardiogenic syncope]] is defined as a syndrome in which triggering of a neural reflex results in a usually self-limited episode of [[Hypotension|systemic hypotension]] characterized by both [[bradycardia]] (asystole or relative bradycardia) and [[vasodilation|peripheral vasodilation]].  
[[Neurocardiogenic syncope]] is defined as a syndrome in which triggering of a neural reflex results in a usually '''''self-limited''''' episode of [[Hypotension|systemic hypotension]] characterized by both [[bradycardia]] (asystole or relative bradycardia) and [[vasodilation|peripheral vasodilation]].  


It is caused by an abnormal or '''''exaggerated autonomic response''''' to various stimuli, commonly standing and emotion.<ref name="pmid12270863">{{cite journal |author=Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W |title=Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing |journal=[[Circulation]] |volume=106 |issue=13 |pages=1684–9 |year=2002 |month=September |pmid=12270863 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12270863 |accessdate=2012-05-17}}</ref><ref name="pmid14623807">{{cite journal |author=Lu CC, Diedrich A, Tung CS, Paranjape SY, Harris PA, Byrne DW, Jordan J, Robertson D |title=Water ingestion as prophylaxis against syncope |journal=[[Circulation]] |volume=108 |issue=21 |pages=2660–5 |year=2003 |month=November |pmid=14623807 |doi=10.1161/01.CIR.0000101966.24899.CB |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14623807 |accessdate=2012-05-17}}</ref> The underlying mechanism for this exaggerate autonomic response remains unclear; however, the activation of cardiac C fibres has shown to play role which subsequently causes reflex-mediated changes in the vascular tone and heart rate.<ref name="pmid11117979">{{cite journal |author=Kapoor WN |title=Syncope |journal=[[The New England Journal of Medicine]] |volume=343 |issue=25 |pages=1856–62 |year=2000 |month=December |pmid=11117979 |doi=10.1056/NEJM200012213432507 |url=http://www.nejm.org/doi/abs/10.1056/NEJM200012213432507?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-05-17}}</ref>  
It is caused by an abnormal or '''''exaggerated autonomic response''''' to various stimuli, commonly standing and emotion.<ref name="pmid12270863">{{cite journal |author=Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W |title=Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing |journal=[[Circulation]] |volume=106 |issue=13 |pages=1684–9 |year=2002 |month=September |pmid=12270863 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12270863 |accessdate=2012-05-17}}</ref><ref name="pmid14623807">{{cite journal |author=Lu CC, Diedrich A, Tung CS, Paranjape SY, Harris PA, Byrne DW, Jordan J, Robertson D |title=Water ingestion as prophylaxis against syncope |journal=[[Circulation]] |volume=108 |issue=21 |pages=2660–5 |year=2003 |month=November |pmid=14623807 |doi=10.1161/01.CIR.0000101966.24899.CB |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=14623807 |accessdate=2012-05-17}}</ref> The underlying mechanism for this exaggerate autonomic response remains unclear; however, the activation of cardiac C fibres has shown to play role which subsequently causes reflex-mediated changes in the vascular tone and heart rate.<ref name="pmid11117979">{{cite journal |author=Kapoor WN |title=Syncope |journal=[[The New England Journal of Medicine]] |volume=343 |issue=25 |pages=1856–62 |year=2000 |month=December |pmid=11117979 |doi=10.1056/NEJM200012213432507 |url=http://www.nejm.org/doi/abs/10.1056/NEJM200012213432507?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-05-17}}</ref>  
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==Pathophysiology==
==Pathophysiology==
The underlying mechanism of exaggerated autonomic response to various stimuli in patients with neurocardiogenic stimuli remains unclear. However, the '''''activation of cardiac C-fibres''''' has been implicated in the pathogenesis of neurocardiogenic syncope.<ref>Fogoros RN. Practical cardiac diagnosis: electrophysiologic testing. 3 rd ed. Malden, MA: Blackwell Publishing, 1999</ref>


Regardless of the triggers, the mechanism of [[syncope]] is similar among various [[vasovagal syncope]] syndromes.
Multiple triggering stimuli activate the [[nucleus tractus solitarius]] of the brainstem directly or indirectly via receptors including the [[cardiac C fibres]] and the [[cardiopulmonary baroreceptors]] which results in the simultaneous enhancement of the [[vagal tone|parasympathetic nervous system (vagal) tone]] and withdrawal of the [[sympathetic nervous system|sympathetic nervous system tone]].<ref>Fogoros RN. Practical cardiac diagnosis: electrophysiologic testing. 3 rd ed. Malden, MA: Blackwell Publishing, 1999</ref><ref name="pmid11117979">{{cite journal |author=Kapoor WN |title=Syncope |journal=[[The New England Journal of Medicine]] |volume=343 |issue=25 |pages=1856–62 |year=2000 |month=December |pmid=11117979 |doi=10.1056/NEJM200012213432507 |url=http://www.nejm.org/doi/abs/10.1056/NEJM200012213432507?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2012-05-17}}</ref><ref name="pmid11465961">{{cite journal |author=Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Moya A, Raviele A, Sutton R, Theodorakis G, Wieling W |title=Guidelines on management (diagnosis and treatment) of syncope |journal=[[European Heart Journal]] |volume=22 |issue=15 |pages=1256–306 |year=2001 |month=August |pmid=11465961 |doi=10.1053/euhj.2001.2739 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=11465961 |accessdate=2012-05-17}}</ref>
This results in a spectrum of hemodynamic responses:
:* On one end of the spectrum is the cardioinhibitory response caused by an '''''increased vagal tone''''' that is characterized by [[bradycardia]] and consequent [[hypotension]] that is significant enough to result in [[loss of consciousness]].
:*On the other end of the spectrum is the vasodepressor response, caused by a [[hypotension|drop in blood pressure]] without much change in [[heart rate]]. This phenomenon occurs due to '''''vasodilation''''', secondary to the withdrawal of [[sympathetic nervous system|sympathetic nervous system tone]].
As a result of increased [[vagal tone]] and [[vasodilation]], [[bradycardia]] and significant reduction in cardiac filling pressures subsequently follow which then causes [[syncope]] or [[loss of consciousness]].


==References==
==References==

Revision as of 12:02, 17 May 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Neurocardiogenic syncope is defined as a syndrome in which triggering of a neural reflex results in a usually self-limited episode of systemic hypotension characterized by both bradycardia (asystole or relative bradycardia) and peripheral vasodilation.

It is caused by an abnormal or exaggerated autonomic response to various stimuli, commonly standing and emotion.[1][2] The underlying mechanism for this exaggerate autonomic response remains unclear; however, the activation of cardiac C fibres has shown to play role which subsequently causes reflex-mediated changes in the vascular tone and heart rate.[3]

On the contrary, failure of autonomic reflex response results in orthostatic hypotension.

Pathophysiology

The underlying mechanism of exaggerated autonomic response to various stimuli in patients with neurocardiogenic stimuli remains unclear. However, the activation of cardiac C-fibres has been implicated in the pathogenesis of neurocardiogenic syncope.[4]

Regardless of the triggers, the mechanism of syncope is similar among various vasovagal syncope syndromes.

Multiple triggering stimuli activate the nucleus tractus solitarius of the brainstem directly or indirectly via receptors including the cardiac C fibres and the cardiopulmonary baroreceptors which results in the simultaneous enhancement of the parasympathetic nervous system (vagal) tone and withdrawal of the sympathetic nervous system tone.[5][3][6]

This results in a spectrum of hemodynamic responses:

  • On one end of the spectrum is the cardioinhibitory response caused by an increased vagal tone that is characterized by bradycardia and consequent hypotension that is significant enough to result in loss of consciousness.

As a result of increased vagal tone and vasodilation, bradycardia and significant reduction in cardiac filling pressures subsequently follow which then causes syncope or loss of consciousness.

References

  1. Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W (2002). "Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing". Circulation. 106 (13): 1684–9. PMID 12270863. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  2. Lu CC, Diedrich A, Tung CS, Paranjape SY, Harris PA, Byrne DW, Jordan J, Robertson D (2003). "Water ingestion as prophylaxis against syncope". Circulation. 108 (21): 2660–5. doi:10.1161/01.CIR.0000101966.24899.CB. PMID 14623807. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  3. 3.0 3.1 Kapoor WN (2000). "Syncope". The New England Journal of Medicine. 343 (25): 1856–62. doi:10.1056/NEJM200012213432507. PMID 11117979. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)
  4. Fogoros RN. Practical cardiac diagnosis: electrophysiologic testing. 3 rd ed. Malden, MA: Blackwell Publishing, 1999
  5. Fogoros RN. Practical cardiac diagnosis: electrophysiologic testing. 3 rd ed. Malden, MA: Blackwell Publishing, 1999
  6. Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, van Dijk JG, Fitzpatrick A, Hohnloser S, Janousek J, Kapoor W, Kenny RA, Kulakowski P, Moya A, Raviele A, Sutton R, Theodorakis G, Wieling W (2001). "Guidelines on management (diagnosis and treatment) of syncope". European Heart Journal. 22 (15): 1256–306. doi:10.1053/euhj.2001.2739. PMID 11465961. Retrieved 2012-05-17. Unknown parameter |month= ignored (help)

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