The child with recurrent syncope: autonomic function testing and beta-adrenergic hypersensitivity.

J C Perry; A Garson

doi:10.1016/0735-1097(91)90849-5

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The child with recurrent syncope: autonomic function testing and beta-adrenergic hypersensitivity.

J C Perry·A Garson

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Abstract

Recurrent syncope in the child with a normal heart poses both diagnostic and therapeutic problems. To assess autonomic contributions to syncope, formal autonomic function testing was performed in 22 children (aged 7 to 18 years) with recurrent syncope and a normal heart. Autonomic testing consisted of eight to nine separate tests; 14 of the 22 patients had reproduction of syncope or symptoms during testing. Patients with a positive test had a lower norepinephrine level while supine (334 +/- 86 versus 547 +/- 169 pg/ml, p less than 0.01) and lower norepinephrine level in the upright position (628 +/- 219 versus 891 +/- 270 pg/ml, p less than 0.05) than did patients with a negative test. The slope of heart rate response versus log isoproterenol dose was greater in patients with a positive test than in those with a negative test (1.70 +/- 0.70 versus 0.89 +/- 0.19, p less than 0.01). All five patients with a positive test who were given intravenous propranolol had elimination of syncope with repeat testing. Eight of 10 patients with a positive test were successfully treated with atenolol, including 2 patients without prior resolution of symptoms after pacemaker implantation for symptoms attributed to bradycardia. Beta-adrenergic hypersensitivity may cause recurrent syncope in young patients. Inappropriate heart rate response to standing may elicit the Bezold-Jarisch reflex, resulting in bradycardia or hypotension, or both, in some patients. Beta-adrenergic blockade is of benefit in many of these patients.

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Adolescent Adrenergic beta-Antagonists Atenolol Autonomic Nervous System Child Epinephrine Female Follow-Up Studies Humans Isoproterenol Male Norepinephrine Posture Propranolol Receptors, Adrenergic, beta Recurrence Syncope Journal Article

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J C Perry, A Garson. 1991. The child with recurrent syncope: autonomic function testing and beta-adrenergic hypersensitivity.. https://doi.org/10.1016/0735-1097(91)90849-5

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