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ARTICLE |

Vagal Syncope During Recurrent Pulmonary Embolism FREE

Ross J. Simpson, Jr, MD; Robert Podolak, MD; Charles A. Mangano, Jr, MD; James R. Foster, MD; Frederic G. Dalldorf, MD
[+] Author Affiliations

Reprint requests to University of North Carolina, 349 Clinical Sciences Bldg 229-H, Chapel Hill, NC 27514 (Dr Simpson).


JAMA. 1983;249(3):390-393. doi:10.1001/jama.1983.03330270054034
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The mechanism for syncope during pulmonary embolism is not well understood. We describe two patients with transient sinus bradycardia and atrioventricular (AV) block during syncope from recurrent pulmonary embolism. Consciousness was regained each time the rhythm returned to normal. We believe that the syncope and bradyarrhythmia was caused by a parasympathetic reflex, since simultaneous slowing of the sinus rate with concomitant AV block is a common manifestation of increased vagal tone. Such a reflex is consistent with known cardiac reflexes, may occur frequently, and may be one of the mechanisms for syncope in patients with pulmonary embolism.

(JAMA 1983;249:390-393)

REFERENCES

Thames MD, Alpert JS, Dalen JE:  Syncope in patients with pulmonary embolism . JAMA 1977;;238:2509-2511.
Bell WR, Simon TL, DeMets DL:  The clinical features of submassive and massive pulmonary embolism . Am J Med 1977;;62:355-360.
Stein PD, Dalen JE, McIntyre KM, et al:  The electrocardiogram in acute pulmonary embolism . Prog Cardiovasc Dis 1975;;17:247-257.
Linden RJ:  Reflexes from the heart . Prog Cardiovasc Dis 1975;;18:201-222.
Oberg B, Thoren P:  Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat: A possible cause of the vaso-vagal reaction . Acta Physiol Scand 1972;;85:164-173.
Thoren P:  Reflex bradycardia elicited from left ventricular receptors during acute severe hypoxia in cats . Acta Physiol Scand 1973;;87:103-112.
Massie B, Scheinman MM, Peters R, et al:  Clinical and electrophysiologic findings in patients with paroxysmal slowing of the sinus rate and apparent Mobitz type II atrioventricular block . Circulation 1978;;58:305-314.
James TN, Urthaler F, Hageman GR:  Reflex heart block: Baroreflex, chemoreflex and bronchopulmonary reflex causes . Am J Cardiol 1980;;45:1182-1188.
Barcroft H, Edholm OG, McMichael J, et al:  Posthaemorrhagic fainting: Study by cardiac output and forearm flow . Lancet 1944;;1:489-491.
Eckberg DL:  Parasympathetic cardiovascular control in humans , in Levy M, Vasalle M (eds): Excitation and Neural Control of the Heart . Bethesda, Md, American Physiologic Society, 1982;, pp 275-297.
Tilkian AG, Guilleminault C, Schroeder JS, et al:  Sleep-induced apnea syndrome: Reversal of serious arrhythmias after tracheostomy, abstracted . Circulation 1975;;52( (suppl 2) ):2-131.
Greenberg TT, Richmond WH, Stocking RA, et al:  Impaired atrial receptor responses in dogs with heart failure due to tricuspid insufficiency and pulmonary artery stenosis . Circ Res 1973;;32:424-433.

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Thames MD, Alpert JS, Dalen JE:  Syncope in patients with pulmonary embolism . JAMA 1977;;238:2509-2511.
Bell WR, Simon TL, DeMets DL:  The clinical features of submassive and massive pulmonary embolism . Am J Med 1977;;62:355-360.
Stein PD, Dalen JE, McIntyre KM, et al:  The electrocardiogram in acute pulmonary embolism . Prog Cardiovasc Dis 1975;;17:247-257.
Linden RJ:  Reflexes from the heart . Prog Cardiovasc Dis 1975;;18:201-222.
Oberg B, Thoren P:  Increased activity in left ventricular receptors during hemorrhage or occlusion of caval veins in the cat: A possible cause of the vaso-vagal reaction . Acta Physiol Scand 1972;;85:164-173.
Thoren P:  Reflex bradycardia elicited from left ventricular receptors during acute severe hypoxia in cats . Acta Physiol Scand 1973;;87:103-112.
Massie B, Scheinman MM, Peters R, et al:  Clinical and electrophysiologic findings in patients with paroxysmal slowing of the sinus rate and apparent Mobitz type II atrioventricular block . Circulation 1978;;58:305-314.
James TN, Urthaler F, Hageman GR:  Reflex heart block: Baroreflex, chemoreflex and bronchopulmonary reflex causes . Am J Cardiol 1980;;45:1182-1188.
Barcroft H, Edholm OG, McMichael J, et al:  Posthaemorrhagic fainting: Study by cardiac output and forearm flow . Lancet 1944;;1:489-491.
Eckberg DL:  Parasympathetic cardiovascular control in humans , in Levy M, Vasalle M (eds): Excitation and Neural Control of the Heart . Bethesda, Md, American Physiologic Society, 1982;, pp 275-297.
Tilkian AG, Guilleminault C, Schroeder JS, et al:  Sleep-induced apnea syndrome: Reversal of serious arrhythmias after tracheostomy, abstracted . Circulation 1975;;52( (suppl 2) ):2-131.
Greenberg TT, Richmond WH, Stocking RA, et al:  Impaired atrial receptor responses in dogs with heart failure due to tricuspid insufficiency and pulmonary artery stenosis . Circ Res 1973;;32:424-433.
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