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Vasovagal Fainting: A Diphasic Response
Abstract
Vasovagal (vasodepressor) fainting was studied in three different situations: in persons donating blood, in persons having a simple venipuncture, and in patients undergoing pneumoencephalography. Ten faints were observed in the first situation, 7 in the second and 6 in the third. In all instances, the faint itself, characterized by low blood pressure and bradycardia, was the second phase of a diphasic response; the first phase was characterized by rapid or rising heart rate, and by rising blood pressure, especially diastolic. The data are compatible with the view that the first (hyperdynamic) phase is a reflection of anxiety, while the second phase begins with the sudden cessation of anxiety. It is suggested that physiologically the faint reflects the action of reflex mechanisms activated by the first phase, and then left suddenly unopposed. The other psychobiological interpretations exhibit inconsistencies because they fail to recognize the diphasic nature of this response. Fainting and dying resemble each other closely, and there is reason to think that some vasovagal faints are fatal. Cardiac asystole is not rare in faints and is often associated with convulsions. Apnea was observed in 2 of our subjects. Disturbances of cardiac rhythm, including A. V. nodal rhythm, interference dissociation, and asystole (in 1 instance for 18 sec.) were observed. Generalized convulsions were seen on four occasions, always in association with asystole.
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In the citing paper
“Consequently, common knowledge in this area draws heavily on earlier research on emotional fainting (Engel, 1978; Graham et al., 1961) and textbook entries for BII phobia tend to focus strongly on fainting and the diphasic response pattern as fundamental characteristics of this disorder (Barlow & Durand, 2005).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“Graham et al. (1961) interpreted diastolic response patterns as diphasic even when they did not show decreases below initial levels.”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“Earlier research also suggested that the initial phase before onset of syncope is characterized by increases in both HR and BP (Graham et al., 1961; Engel & Romano, 1947).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“In Graham et al. (1961), data from two groups of blood donors who fainted during blood draws showed increases in SBP and HR before venipuncture and falls in these parameters below baseline level following the procedure. DBP values showed increases with subsequent decreases, but they did not exhibit falls below baseline.”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“In terms of practicality, the prevalence of pre-syncope can be expected to be higher because a number of patients never fulfill “hard criteria” for syncope (Graham et al., 1961).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“In the work of both authors, the clearest demonstrations of a cardiovascular adjustment pattern with two phases, including the initial rise in HR and BP followed by subsequent falls, were based on case studies.”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“The origins of such “soft criteria” of fainting might also lie in Graham et al.’s (1961) earlier definition of fainting as a sudden drop in BP and pulse rate accompanied by reports of disturbance of consciousness described as feeling “dizzy,” lightheaded,” or “woozy.””
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“In addition, a considerable number of patients may actually show strongest symptoms after termination of exposure (Graham et al., 1961; Kleinknecht et al., 1990).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al., 1961
In the citing paper
“Graham et al. (1961) noted that in their observations of fainting, asystole, as well as falls in BP and apnea, presented “a picture indistinguishable from death” (p. 505).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Graham et al. (1961)
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“The subsequent second phase is characterized by a sharp fall in HR (bradycardia) as well as BP (hypotension) leading to reduced cerebral blood flow and ultimately fainting (e.g., Graham et al., 1961).”
BackgroundInfluentialCaseras, X., Giampietro, V., Lamas, A., Brammer, M., Vilarroya, O., Carmona, S., Rovira, M., Torrubia, R., & Mataix-Cols, D. (2010) · Psychological Medicine · doi:10.1017/s0033291709005972 · Cited by 69
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Wannemueller, A., Fasbender, A., Kampmann, Z., Weiser, K., Schaumburg, S., Velten, J., & Margraf, J. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01534 · Cited by 10
Metadata
- Authors
- GRAHAM, D. T., KABLER, J. D., & LUNSFORD, L.
- Affiliations
- University of Wisconsin–Madison (US)
- ORCID
- GRAHAM, DAVID T.
- Venue
- Psychosomatic Medicine
- Published
- 1961-11
- Volume
- 23
- Issue
- 6
- Pages
- 493-507
- ISSN
- 0033-3174 (ISSN-L)
- OpenAlex
- W2324480100
- Cited by
- 157
- References
- 0
- Citations by year
- 2024: 2 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 5 · 2012: 8
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- vasovagal syncope, blood donation, venipuncture, pneumoencephalography, anxiety, bradycardia, hypotension, reflex mechanisms, asystole, generalized convulsions, apnea, cardiac arrhythmias
- MeSH terms
- Blood Pressure, Blood Pressure Determination, Humans, Syncope
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