Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation

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Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation. / Prasad, K; Williams, Lynne; Campbell, R; Elliott, PM; McKenna, WJ; Frenneaux, Michael.

In: Heart, Vol. 94, No. 10, 01.10.2008, p. 1312-1317.

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Prasad, K ; Williams, Lynne ; Campbell, R ; Elliott, PM ; McKenna, WJ ; Frenneaux, Michael. / Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation. In: Heart. 2008 ; Vol. 94, No. 10. pp. 1312-1317.

Bibtex

@article{2cf92e0268204dc8a8244d7ce0983420,
title = "Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation",
abstract = "Symptoms of impaired consciousness (syncope and presyncope) occur in 15-25% of patients with hypertrophic cardiomyopathy (HCM).(1) In young patients a history of recurrent syncope is associated with an increased risk of sudden death.(2) (5) Syncope usually occurs without warning or symptoms suggestive of the cause. Detailed investigations identify a probable mechanism in a minority, usually paroxysmal atrial fibrillation or ventricular tachycardia. In the majority however no likely mechanism is found despite repeated 24-hour ambulatory echocardiography (ECG) or patient-activated monitoring, exercise testing and invasive electrophysiological studies.(1) (6) Empirical treatment with amiodarone, a pacemaker or an implantable cardioverter-defibrillator is commonly employed, but is often unsuccessful in relieving the symptoms. We have previously observed that approximately 30% of patients with HCM have abnormal blood pressure response during maximal upright exercise.(7) (8) This was due in the majority of patients to an exaggerated fall in systemic vascular resistance, possibly arising from abnormal activation of stretch-sensitive left ventricular mechanoreceptors,(9) (10) by a mechanism similar to that described in aortic stenosis.(11) However, in some patients an inadequate cardiac output response to exercise may be responsible.(12) We hypothesised that abnormal vasodepressor-mediated hypotension may also occur during daily life in patients with HCM, and that this may be an important mechanism of syncope when conventional investigations fail to reveal a cause.",
author = "K Prasad and Lynne Williams and R Campbell and PM Elliott and WJ McKenna and Michael Frenneaux",
year = "2008",
month = oct,
day = "1",
doi = "10.1136/hrt.2008.141507",
language = "English",
volume = "94",
pages = "1312--1317",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "10",

}

RIS

TY - JOUR

T1 - Episodic syncope in hypertrophic cardiomyopathy: evidence for inappropriate vasodilation

AU - Prasad, K

AU - Williams, Lynne

AU - Campbell, R

AU - Elliott, PM

AU - McKenna, WJ

AU - Frenneaux, Michael

PY - 2008/10/1

Y1 - 2008/10/1

N2 - Symptoms of impaired consciousness (syncope and presyncope) occur in 15-25% of patients with hypertrophic cardiomyopathy (HCM).(1) In young patients a history of recurrent syncope is associated with an increased risk of sudden death.(2) (5) Syncope usually occurs without warning or symptoms suggestive of the cause. Detailed investigations identify a probable mechanism in a minority, usually paroxysmal atrial fibrillation or ventricular tachycardia. In the majority however no likely mechanism is found despite repeated 24-hour ambulatory echocardiography (ECG) or patient-activated monitoring, exercise testing and invasive electrophysiological studies.(1) (6) Empirical treatment with amiodarone, a pacemaker or an implantable cardioverter-defibrillator is commonly employed, but is often unsuccessful in relieving the symptoms. We have previously observed that approximately 30% of patients with HCM have abnormal blood pressure response during maximal upright exercise.(7) (8) This was due in the majority of patients to an exaggerated fall in systemic vascular resistance, possibly arising from abnormal activation of stretch-sensitive left ventricular mechanoreceptors,(9) (10) by a mechanism similar to that described in aortic stenosis.(11) However, in some patients an inadequate cardiac output response to exercise may be responsible.(12) We hypothesised that abnormal vasodepressor-mediated hypotension may also occur during daily life in patients with HCM, and that this may be an important mechanism of syncope when conventional investigations fail to reveal a cause.

AB - Symptoms of impaired consciousness (syncope and presyncope) occur in 15-25% of patients with hypertrophic cardiomyopathy (HCM).(1) In young patients a history of recurrent syncope is associated with an increased risk of sudden death.(2) (5) Syncope usually occurs without warning or symptoms suggestive of the cause. Detailed investigations identify a probable mechanism in a minority, usually paroxysmal atrial fibrillation or ventricular tachycardia. In the majority however no likely mechanism is found despite repeated 24-hour ambulatory echocardiography (ECG) or patient-activated monitoring, exercise testing and invasive electrophysiological studies.(1) (6) Empirical treatment with amiodarone, a pacemaker or an implantable cardioverter-defibrillator is commonly employed, but is often unsuccessful in relieving the symptoms. We have previously observed that approximately 30% of patients with HCM have abnormal blood pressure response during maximal upright exercise.(7) (8) This was due in the majority of patients to an exaggerated fall in systemic vascular resistance, possibly arising from abnormal activation of stretch-sensitive left ventricular mechanoreceptors,(9) (10) by a mechanism similar to that described in aortic stenosis.(11) However, in some patients an inadequate cardiac output response to exercise may be responsible.(12) We hypothesised that abnormal vasodepressor-mediated hypotension may also occur during daily life in patients with HCM, and that this may be an important mechanism of syncope when conventional investigations fail to reveal a cause.

U2 - 10.1136/hrt.2008.141507

DO - 10.1136/hrt.2008.141507

M3 - Article

C2 - 18653581

VL - 94

SP - 1312

EP - 1317

JO - Heart

JF - Heart

SN - 1355-6037

IS - 10

ER -