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(Circulation. 2001;104:1326.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pulmonary and Systemic Arterial Pressure Changes During Syncope in Primary Pulmonary Hypertension

Ghada W. Mikhail, MRCP, MD; J. Simon R. Gibbs, MRCP, MD; Magdi H. Yacoub, FRS

From the Department of Cardiology, Royal Brompton and Harefield NHS Trust (G.W.M.); the Department of Clinical Cardiology, National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, and Hammersmith Hospitals NHS Trust (J.S.R.G.); and the Department of Cardiothoracic Surgery and Transplantation, National Heart and Lung Institute, Imperial College of Science, Technology, and Medicine, and Royal Brompton and Harefield NHS Trust (M.H.Y.), London, UK.

Correspondence to Professor Sir Magdi Yacoub, Department of Cardiothoracic Surgery and Transplantation, Royal Brompton and Harefield NHS Trust, Sydney St, London SW3 6NP. E-mail my{at}rbh.nthames.nhs.uk

A 49-year-old woman with primary pulmonary hypertension diagnosed 1 year previously was admitted as part of a research study at Harefield Hospital. She had no known precipitating factors or family history of the disease. Her main symptoms included exertional dyspnea and syncope. Her pulmonary artery systolic pressure was 110 mm Hg, with a mean pulmonary artery pressure of 85 mm Hg. A 24-hour ambulatory pulmonary artery 7F NIH catheter (Gaeltec Ltd) was inserted into the proximal pulmonary artery via the right internal jugular vein. The catheter was plugged into a battery-powered ambulatory recorder (type 7 MPR, Gaeltec Ltd), which was carried by the patient on a shoulder strap. A radial arterial line was also inserted, and a transducer was connected to a second terminal of the recorder box, thus allowing simultaneous continuous measurements of pulmonary and systemic arterial pressures. The patient had a spontaneous syncopal attack during the night recording while lying in bed awake. For 15 minutes before the onset of syncope (Figures 1 and 2), there was a rapid rise in systolic pulmonary artery pressure (from 118 to 126 mm Hg), with a simultaneous gradual decrease in systemic arterial pressure and heart rate. During the recovery phase, there was a simultaneous increase in pulmonary and systemic arterial pressures (Figures 1 and 2). Both of these pressures remained elevated for a period of 30 minutes before returning to baseline.

View larger version (29K): [in this window] [in a new window]   Figure 1. Simultaneous recording of pulmonary and systemic arterial pressures. During syncope, there was a simultaneous decrease in heart rate and in pulmonary and systemic arterial pressures. During presyncopal phase, pulmonary artery pressure was higher than rest of night recording (Figure 2).

View larger version (16K): [in this window] [in a new window]   Figure 2. During presyncope, a sudden rise in pulmonary arterial pressure was accompanied by a gradual decrease in systemic arterial pressure. In recovery phase, there was a simultaneous rise in both pulmonary and systemic arterial pressures, both of which remained high for a period of 30 minutes before returning to baseline.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mikhail, G. W. Articles by Yacoub, M. H. Search for Related Content PubMed PubMed Citation Articles by Mikhail, G. W. Articles by Yacoub, M. H.