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- Title
Enhanced vascular responses to hypocapnia in neurally mediated syncope.
- Authors
Norcliffe-Kaufmann, Lucy Jane; Kaufmann, Horacio; Hainsworth, Roger
- Abstract
Objective The susceptibility to suffer neurally mediated syncope and loss of consciousness varies markedly. In addition to vasodilatation and bradycardia, hyperventilation precedes loss of consciousness. The resultant hypocapnia causes cerebral vasoconstriction and peripheral vasodilatation. We postulate that more pronounced cerebral and peripheral vascular responses to reductions in arterial CO2 levels underlie greater susceptibility to neurally mediated syncope. Methods We compared vascular responses to CO2 among 31 patients with histories of recurrent neurally mediated syncope and low orthostatic tolerance and 14 age- and sex-matched control subjects with no history of syncope and normal orthostatic tolerance. Vascular responses to CO2 were calculated after all subjects had fully recovered and their blood pressures and heart rates were stable. We measured blood flow velocity in the middle cerebral artery (transcranial Doppler) and in the left brachial artery (brachial Doppler), and end-tidal CO2 during voluntary hyperventilation and hypoventilation (end-tidal CO2 from 21-45mm Hg), and determined the slopes of the relations. Results Hypocapnia produced a significantly greater reduction in cerebral blood flow velocity and in forearm vascular resistance in patients with neurally mediated syncope than in control subjects. Opposite changes occurred in response to hypercapnia. In all subjects, the changes in cerebral blood flow velocity and forearm vasodilatation were inversely related with orthostatic tolerance. Interpretation Susceptibility to neurally mediated syncope can be explained, at least in part, by enhanced cerebral vasoconstriction and peripheral vasodilatation in response to hypocapnia. This may have therapeutic implications. Ann Neurol 2007
- Publication
Annals of Neurology, 2008, Vol 63, Issue 3, p288
- ISSN
0364-5134
- Publication type
Article
- DOI
10.1002/ana.21205