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(Circulation. 2005;111:2997-3006.)
© 2005 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Neurocardiogenic Syncope and Related Disorders of Orthostatic Intolerance

Blair P. Grubb, MD

From the Cardiology Department of Medicine, the Medical University of Ohio, Toledo, Ohio.

Correspondence to Blair P. Grubb, MD, Cardiology, Medical University of Ohio, 3000 Arlington Ave, Toledo, OH 43614. E-mail bgrubb@mco.edu

Received September 14, 2004; revision received January 31, 2005; accepted March 9, 2005.

Key Words: nervous system, autonomic • syncope • hypotension, orthostatic

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

"We shall not cease from exploration and the end of all our exploring will be to arrive where we started and know the place for the first time"

— —T.S. Eliot, Four Quartets

Syncope, defined as transient loss of consciousness and postural tone with spontaneous recovery, has both challenged and perplexed physicians since the dawn of recorded time. The earliest written accounts come from Hippocrates, and the word syncope itself is derived from an old Greek term meaning "to cut short" or "interrupt." Recurrent episodes of syncope may result from a large number of different disorders, all of which cause a transitory reduction in cerebral blood flow sufficient to disturb the normal functions of the brain. Over the last 2 decades, considerable attention has been given to types of syncope that occur due to a centrally mediated (or "reflex") fall in systemic blood pressure, a condition that has been referred to as vasovagal (and later neurocardiogenic) syncope. However, research into the nature of this disorder revealed that it is but one aspect of a broad and varied group of disturbances in the normal functioning of the autonomic nervous system (ANS), each of which may result in orthostatic intolerance, hypotension, and ultimately syncope. Continued investigations into the nature of these similar yet different disorders has led to the development of a system of classification that attempts to more accurately reflect our understanding of these conditions and their interrelationships.¹

The present system of classification has proven both functional and clinically relevant and . . . [Full Text of this Article]

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