Aortic stenosis and autonomic dysfunction: co-conspirators in syncope
Abstract
Autonomic dysfunction and aortic stenosis share several clinical characteristics, including, in severe cases, syncope. Both illnesses tend to manifest later in life, and most cases are idiopathic in origin. In a short period of 4 weeks, the authors noted that three patients out of 36 referrals for autonomic dysfunction also had histories of aortic valve replacement due to stenosis. In each case, similar presenting symptoms of fatigue, light-headedness, and syncope were attributed to aortic stenosis without mention of autonomic failure as a possible contributor. The authors propose that patients for whom symptoms of aortic valve stenosis are not relieved by surgical intervention may have concomitant autonomic dysfunction contributing significantly to their symptoms. Furthermore, the two conditions may comprise a dangerous combination, aortic stenosis causing physical obstruction of ventricular outflow, and autonomic dysfunction causing decreased venous return and insufficient cardiac filling. It may be beneficial for patients with aortic stenosis who present with syncope to be considered for possible autonomic dysfunction to address both potential pathophysiologies contributing to the syncope.
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Multifactorial mechanisms are likely in other types of cardiac syncope, e.g. aortic stenosis, hypertrophic cardiomyopathy (HCM), and sick sinus syndrome.
“Similarly, multifactorial mechanisms are likely in other types of cardiac syncope, e.g. aortic stenosis, 133 hypertrophic cardiomyopathy (HCM), 134 and sick sinus syndrome. 135,136”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [133]
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2018 ESC Guidelines for the diagnosis and management of syncope
Brignole, M., Moya, A., de Lange, F. J., Deharo, J.-C., Elliott, P. M., Fanciulli, A., Fedorowski, A., Furlan, R., Kenny, R. A., Martín, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy037 · Cited by 1,951 · see citing works
Sutton, R., & Brignole, M. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu255 · Cited by 127 · see citing works
- Authors
- Taneja, I., Marney, A., & Robertson, D.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Robertson, David
- ORCID
- Robertson, David
- Venue
- The American Journal of the Medical Sciences
- Publisher
- Elsevier BV
- Published
- 2004-05
- Volume
- 327
- Issue
- 5
- Pages
- 281-283
- ISSN
- 0002-9629 (ISSN-L)
- OpenAlex
- W1990948318
- Cited by
- 10
- References
- 10
- Citations by year
- 2019: 1 · 2018: 4 · 2016: 1 · 2014: 2
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of the Medical Sciences (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL56693, P01HL056693)
- National Center for Research Resources (RR00095)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- aortic stenosis, autonomic dysfunction, syncope, aortic valve replacement, differential diagnosis, venous return, cardiac filling, fatigue, lightheadedness, outflow obstruction
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve Stenosis, Autonomic Nervous System Diseases, Humans, Hypotension, Orthostatic, Male, Syncope, Comorbidity, Heart Valve Prosthesis Implantation
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