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Cited by 28Cardiovascular Syncope and Autonomic DisordersHeart Rate Variability and Autonomic ControlVestibular and auditory disorders

The role of autonomic testing in syncope

Jones, Pearl K., Gibbons, Christopher H.·2014·Autonomic Neuroscience
DOI 10.1016/j.autneu.2014.05.011
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Abstract

Syncope is a common presenting complaint in both the inpatient and outpatient settings. The main goals in the clinical evaluation of syncope are to identify an underlying etiology, to stratify risk and to guide plans for therapeutic intervention. Testing begins with an initial electrocardiogram to screen for any cardiac rhythm abnormalities. Heart rate variability to paced breathing provides a standard measure of cardiac parasympathetic function and offers clues towards an autonomic cause of syncope. A Valsalva maneuver is used to evaluate for parasympathetic dysfunction through the Valsalva ratio. In addition, sympathetic adrenergic function is assessed through evaluation of blood pressure response during the Valsalva maneuver. Abnormalities to the Valsalva maneuver can suggest clues towards an autonomic cause of syncope. Head-up tilt table testing is an important part of the autonomic evaluation of patients with syncope, and can be diagnostic for many disorders that result in syncope including orthostatic hypotension, neurally mediated syncope, postural tachycardia syndrome or delayed orthostatic hypotension. Autonomic function testing provides a safe and controlled environment for evaluation of patients, and plays a pivotal role in the diagnosis of syncope, particularly in challenging cases. While the initial clinical evaluation of syncope involves a detailed history and physical examination; in situations where the diagnosis is unknown, the addition of autonomic testing is complementary and can lead to identification of autonomic causes of syncope.

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Crossref · 10.1016/j.autneu.2014.05.011

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  • The absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure.

    “There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [141]

  • The degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms.

    “There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [141]

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Authors
Jones, P. K., & Gibbons, C. H.
Affiliations
Beth Israel Deaconess Medical Center (US)
ORCID
Gibbons, Christopher H.
Venue
Autonomic Neuroscience
Publisher
Elsevier BV
Published
2014-09
Volume
184
Pages
40-45
ISSN
1566-0702 (ISSN-L)
DOI
10.1016/j.autneu.2014.05.011
OpenAlex
W2040770183
Cited by
28
References
36
Citations by year
2026: 3 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 2
FWCI
3.30
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Autonomic Neuroscience (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
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
Keywords
syncope, autonomic function testing, heart rate variability, Valsalva maneuver, Valsalva ratio, tilt table test, orthostatic hypotension, neurally mediated syncope, postural orthostatic tachycardia syndrome, syncope etiology
MeSH terms
Autonomic Nervous System, Autonomic Nervous System Diseases, Diagnosis, Differential, Humans, Physical Examination, Risk, Syncope

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