Long lasting neurocardiogenic reflex provoked by emotional trigger

A 53-year-old man presented with a protracted presyncope and profound hypotension and bradycardia due to emotion related vasovagal reaction. Electrocardiogram obtained 20 minutes after the onset of presyncope revealed junctional rhythm at 38 beats per minute (bpm). After supination, clinical symptoms and hemodynamic disturbances immediately resolved. Careful cardiologic evaluation revealed significant stenosed coronary vessels. Maintaining the vertical position may be responsible for persistent bradycardia and hypotension after neurocardiogenic reflex provocation.

neurocardiogenic synco-pe, cardiovascular event

1. Brignole M, Sutton R, Wieling W, Lu SN, Erickson MK, Markowitz T, et al. Analysis of rhythm variation during spontaneous cardioinhibitory neurally-mediated syncope. Europace 2007;9:305-11.

2. Zy􀀂ko D, Gajek J, Kozluk E, Agrawal AK, Smereka J, Checiñski I. The clinical relevance of the duration of loss of consciousness provoked by tilt testing. Acta Cardiol 2010;65:203-9.

3. Goolamali SI, Loh VL, Sopher M. The head-up tilt test - a cause of myocardial infarction. Europace 2004;6:548-51.

4. Gajek J, Zy􀀂ko D. Stroke and tilt table testing. Folia Cardiol 2002;9:583-6.

5. Zy􀀂ko D, Gajek J, Smereka J, Chêciñski I, 􀀁ciborski R, Mazurek W. ST-elevation in a patient with vasovagal syncope Folia Cardiol 2006;13:530-3.

6. Rudnicki J, Zy􀀂ko D, Gajek J, Kuliczkowski W, Rosiñczuk-Tonderys J, Zieliñska D, et al. The Risk for Syncope and Presyncope During Surgery in Surgeons and Nurses. Pacing Clin Electrophysiol 2011;34:1486-91.

7. Zy􀀂ko D, Gajek J, Agrawal AK, Rudnicki J. The clinical relevance of a junctional rhythm during neurocardiogenic reaction provoked by tilt testing. Kardiol Pol 2012;70:148-55.

8. Gajek J, Zy􀀁ko D, Agrawal AK, Rudnicki J. Patients with atrioventricular block during tilt test-induced vasovagal syncope. Adv Clin Exp Med 2011;20:305-12.