Document Detail


Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope.
MedLine Citation:
PMID:  12475469     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We hypothesized that isometric arm exercises were able to increase blood pressure (BP) during the phase of impending vasovagal syncope and allow the patient to avoid losing consciousness. BACKGROUND: Hypotension is always present during the prodromal phase of vasovagal syncope. METHODS: We evaluated the effect of handgrip (HG) and arm-tensing in 19 patients affected by tilt-induced vasovagal syncope. The study consisted of an acute single-blind, placebo-controlled, randomized, cross-over tilt-table efficacy study and a clinical follow-up feasibility study. RESULTS: In the acute tilt study, HG was administered for 2 min, starting at the time of onset of symptoms of impending syncope. In the active arm, HG caused an increase in systolic blood pressure (SBP) from 92 +/- 10 mm Hg to 105 +/- 38 mm Hg, whereas in the placebo arm SBP decreased from 91 +/- 11 mm Hg to 73 +/- 21 mm Hg (p = 0.008). Heart rate behavior was similar in the two arms. In the active arm, 63% of patients became asymptomatic, versus 11% in the control arm (p = 0.02); conversely, only 5% of patients developed syncope, versus 47% in the control arm (p = 0.01). The patients were trained to self-administer arm-tensing treatment as soon as symptoms of impending syncope occurred. During 9 +/- 3 months of follow-up, the treatment was actually performed in 95/97 episodes of impending syncope (98%) and was successful in 94/95 (99%). No patients suffered injury or other adverse morbidity related to the relapses. CONCLUSIONS: Isometric arm contraction is able to abort impending vasovagal syncope by increasing systemic BP. Arm counter-pressure maneuvers can be proposed as a new, feasible, safe, and well accepted first-line treatment for vasovagal syncope.
Authors:
Michele Brignole; Francesco Croci; Carlo Menozzi; Alberto Solano; Paolo Donateo; Daniele Oddone; Enrico Puggioni; Gino Lolli
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Dec 
Date Detail:
Created Date:  2002-12-11     Completed Date:  2003-01-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2053-9     Citation Subset:  AIM; IM    
Affiliation:
Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy. mbrignole@ASL4.liguria.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Arm / blood supply*,  physiology*
Blood Pressure / physiology*
Diastole / physiology
Electric Impedance
Electrophysiologic Techniques, Cardiac
Exercise Test
Feasibility Studies
Female
Follow-Up Studies
Hand Strength / physiology
Heart Rate / physiology
Humans
Isometric Contraction / physiology*
Male
Middle Aged
Patient Satisfaction
Reproducibility of Results
Syncope, Vasovagal / physiopathology*
Systole / physiology
Tilt-Table Test

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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