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Cited by 46Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlCardiovascular and exercise physiology

Abnormal reflex venous function in patients with neuromediated syncope

Open access
Manyari, Dante E., Rose, Sarah, Tyberg, John V., Sheldon, Robert S.·1996·Journal of the American College of Cardiology
DOI 10.1016/0735-1097(96)00051-4
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Abstract

Objectives We sought to compare the forearm reflex venous response to mental arithmetic stress in patients with neuromediated syncope and in normal subjects.Background Patients with neuromediated syncope have a paradoxic arterial vasodilation in response to stressors that usually provoke vasoconstriction. Given the postulated role of diminished preload in provoking the reflex responses resulting in syncope, we hypothesized that mental stress might provoke paradoxic reflex venodilation in patients with neuromediated syncope.Methods Twelve normal subjects (mean age [+/-SD] 47 +/- 9 years) and 27 patients with neuromediated syncope (mean age 42 +/- 13 years) were studied before and during a mental arithmetic stress test. Forearm venous pressure-volume relations were determined by using radionuclide plethysmography.Results During mental arithmetic stress, heart rate and systolic and diastolic blood pressure increased significantly and similarly both in normal subjects and in patients with neuromediated syncope. The heart rate and blood pressure changes were qualitatively similar in both groups. However, with mental arithmetic stress, forearm venoconstriction of 13 +/- 2% (mean +/- SEM) was noted in normal subjects (p < 0.001) but not in patients with neuromediated syncope (mean 2%, p = NS). This group response of patients with neuromediated syncope did not result from a lack of individual responses but occurred because these patients had a wide range of responses. The normal physiologic and methodologic variability of the method was +/- 4%. Thirteen of the 27 patients with neuromediated syncope had forearm venoconstriction of 14.5 +/- 6.8% during mental arithmetic stress, whereas 7 had paradoxic forearm venodilation of 14.6 +/- 8.8%, and 7 were considered nonresponders (-1.3 +/- 3.4%). Thus, 14 (52%) of the 27 patients with syncope did not have normal vasoconstriction in response to mental stress.Conclusions Patients with neuromediated syncope have an abnormal range of forearm venomotor responses to mental arithmetic stress. Reflex control of the veins may play an important role in the pathogenesis of neuromediated syncope.

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  • During a vasovagal syncope episode, an ineffective reflex response causes venous pooling in peripheral and/or splanchnic regions.

    “During a vasovagal syncope episode, an ineffective reflex response causes venous pooling in the periphery and/or splanchnic regions.73–76”

    From 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope (2015) · cites this paper as [76]

    The Discussion reports greater calf venous pooling during tilt-induced syncope and suggests that reduced venous responsiveness to sympathetic stimulation may explain it. The paper’s own forearm measurements were taken during mental stress, not a syncopal episode; it does not establish the proposed reflex mechanism as a cause or address splanchnic pooling. No page number is available in our copy. (LLM, conf=0.84)

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  • The underlying pathophysiology of VVS results from a reflex causing hypotension and bradycardia, triggered by prolonged standing or exposure to emotional stress, pain, or medical procedures.

    “The underlying pathophysiology of VVS results from a reflex causing hypotension and bradycardia, triggered by prolonged standing or exposure to emotional stress, pain, or medical procedures (361–365).”

    From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [364]

    The Abstract (page not provided) describes a proposed reflex involving decreased vasomotor tone and heart rate, and the Discussion links abnormal vascular responses to orthostatic and mental stress. The paper does not establish prolonged standing, emotional stress, pain, or medical procedures as the specific triggers listed in the claim; its Results report that blood pressure and heart rate rose during the mental-arithmetic test. (LLM, conf=0.85)

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2 of the 38 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [4]4. R&in AM. Risk SJ, Marinchak RA Kwey PR. The bad-up tilt table rest and cardiiov~ manic zsymq. Am Heart J 1993;125:476-(11?.
  2. [8]8. Fitzpatn:k <2, Banner N. cbeng A Yacoub M Sutton R Vaw+ rea&lr may oaur after cahotqk hai uzae+mh J Am Cdl cardid 1993;21:1131-7~

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Authors
Manyari, D. E., Rose, S., Tyberg, J. V., & Sheldon, R. S.
Affiliations
University of Calgary (CA)
Corresponding author
Sheldon, Robert S.
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1996-06
Volume
27
Issue
7
Pages
1730-1735
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/0735-1097(96)00051-4
OpenAlex
W2077642826
Cited by
46
References
38
Citations by year
2025: 1 · 2022: 2 · 2021: 1 · 2018: 2 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 3
FWCI
2.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
Keywords
mental arithmetic stress, venoconstriction, preload
MeSH terms
Adult, Aged, Blood Volume, Female, Forearm, Humans, Male, Mathematics, Middle Aged, Prospective Studies, Reflex, Stress, Psychological, Syncope, Vagus Nerve, Vasodilation, Vasomotor System

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