Images in Clinical Medicine

Neurocardiogenic Syncope

Rolf R. Diehl, Ph.D., and Dieter Linden, M.D.

N Engl J Med 1998; 339:312July 30, 1998

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Figure 1 A 43-year-old man with moderate hypercholesterolemia and a long history of fainting after venipuncture was monitored by transcranial Doppler ultrasonography of the middle cerebral arteries and continuous noninvasive measurement of blood pressure and heart rate during venipuncture to assess cerebrovascular and circulatory changes during syncope. Venipuncture was performed for a routine analysis of blood lipids. For two minutes after venipuncture, the patient's cerebral blood-flow velocities, blood pressure, and heart rate were within normal ranges (Panels A and B). Then, his blood pressure decreased from 100/60 mm Hg to 55/30 mm Hg and his heart rate decreased from 72 beats per minute to 30 beats per minute. Ultrasonography showed little change in systolic velocity but a marked decline in the diastolic value. The patient lost consciousness (Panel C), and 2 minutes after the onset of hypotension there was a 30-second period of asystole followed by a generalized seizure, with recovery within 1 minute. The patient declined treatment because syncope occurred only during venipuncture. During four months of follow-up, there were no further venipunctures or episodes of fainting. The physiologic changes during this type of centrally induced neurocardiogenic syncope are similar to those in neurocardiogenic syncope evoked by tilt-table testing.

Rolf R. Diehl, Ph.D.
Dieter Linden, M.D.
Alfried Krupp Krankenhaus, 45117 Essen-Rüttenscheid, Germany

Citing Articles (5)

Citing Articles

1. 1

   Daniel E Becker, Daniel A Haas. (2011) Recognition and Management of Complications During Moderate and Deep Sedation. Part 2: Cardiovascular Considerations. Anesthesia Progress 58:3, 126-138
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2. 2

   Inder M. Singh, Patrick S. Antoun, Laura Baugh, Dragos Sabau, John C. Bailey. (2008) Cardioinhibitory syncope due to bloodphobia associated asystole. International Journal of Cardiology 130:1, e47-e49
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3. 3

   Rolf R. Diehl. (2005) Vasovagal syncope and Darwinian fitness. Clinical Autonomic Research 15:2, 126-129
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4. 4

   L. Hosie, J. P. Wood, A. N. Thomas. (2001) Vasovagal syncope and anaesthetic practice. European Journal of Anaesthesiology 18:8, 554-557
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5. 5

   (1998) Neurocardiogenic Syncope. New England Journal of Medicine 339:25, 1857-1857
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