Neurocardiogenic syncope: response to hormonal therapy.

Abstract

Vasovagal or neurocardiogenic syncope usually occurs in the upright position as a result of an inappropriate vasomotor response allowing venous pooling. This decrease in venous return is thought to result in vigorous ventricular contractions and activation of cardiac mechanoreceptors. This results in a paradoxic bradycardia and peripheral vascular dilation, further augmenting hypotension. This in turn may lead to cerebral hypoxia and syncope.1,2 Upright tilt table testing has been determined to be a useful provocative tool for evaluating patients with recurrent unexplained syncope.1-20 Although tilt table responses may indicate neurocardiogenic syncope of the classic or dysautonomic pattern or postural orthostatic tachycardia, treatment has been similar. Traditional treatment includes volume expansion, cardioselective β-1 adrenergic blocking agents, anticholinergic agents, methylxanthines, and serotonin reuptake inhibitors.8,20 We retrospectively reviewed a select group of patients with positive tilt table responses who were particularly resistant to traditional therapy. These patients also had coexistent menstrual irregularities. We describe their improvement in symptoms related to neurocardiogenic syncope during treatment with ovarian hormone therapy prescribed to treat their menstrual irregularities. This is a case series of 15 women, seen between 1993 and 1996 at the Medical College of Ohio, who …