Susceptibility to neuromediated syncope after acute myocardial infarction

Background Syncope after acute myocardial infarction (AMI) is a common clinical problem. It may be hypothesised that remodelling and neurohormonal changes following AMI may predispose to neuromediated syncope. Design To address this issue we prospectively evaluated the incidence of positive results...

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Bibliographic Details
Published in:European journal of clinical investigation 2000-05, Vol.30 (5), p.383-388
Main Authors: Wasek, W, Kulakowski, P, Czepiel, A, Klosiewicz--Wasek, B
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - therapeutic use
Adult
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Autonomic nervous system
Autonomic Nervous System - drug effects
Autonomic Nervous System - physiopathology
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Electrocardiography, Ambulatory
Follow-Up Studies
Heart
Humans
Incidence
Male
Medical sciences
Middle Aged
myocardial infarction
Myocardial Infarction - diagnosis
Myocardial Infarction - drug therapy
Myocardial Infarction - epidemiology
Prospective Studies
Risk Factors
Space life sciences
syncope
Syncope - diagnosis
Syncope - epidemiology
Syncope - physiopathology
Tilt-Table Test
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Summary:Background Syncope after acute myocardial infarction (AMI) is a common clinical problem. It may be hypothesised that remodelling and neurohormonal changes following AMI may predispose to neuromediated syncope. Design To address this issue we prospectively evaluated the incidence of positive results of head‐up tilt‐table testing in 40 patients following AMI and 40 age and sex matched controls without a history of syncope. The mechanisms of tilt‐induced changes in autonomic tone were assessed using spectral analysis of heart rate variability. The patients were followed‐up for one year. Results Positive results of tilt‐test occurred in 4 (10%) controls and 13 (33%) AMI patients (P = 0.01). No significant differences in sympathovagal interaction (assessed by a low frequency/high frequency ratio) were detected between the groups before tilting (2.9 ± 1.9 vs. 3.1 ± 2.2; NS). However, dynamic changes of this parameter differed significantly during the first 5 symptomless minutes of the active phase of tilt‐test. The ratio increased in the majority of controls (87%) and decreased in the majority of patients (62%) (P 
ISSN:0014-2972
1365-2362
DOI:10.1046/j.1365-2362.2000.00641.x