Squatting (SQ): position with posterior surfaces of calves pressed against posterior sites of thighs, the trunk is tilted forward, and hands are positioned on the floor. Isometric counter-pressure maneuversįollowing maneuvers were performed in all patients. The vasovagal etiology of syncope was confirmed by head-up tilt test (HUT), which was performed according to Italian protocol (20 min of passive standing in 60° position followed by 15 min of nitroglycerine stimulated test). Clinical history suggested the diagnosis of vasovagal syncope. Study was performed in accordance with declaration of Helsinki and was approved by Ethics committee VUSCH.Įxclusion criteria were: absence of prodromal symptoms, bradycardic and hypotensive drugs, and drugs and diseases influencing the autonomic nervous system activity.Īll patients underwent complete clinical assessment and 12-lead electrocardiogram. All persons gave their informed consent to participate. Inclusion criteria were recurrent syncope, absence of structural heart disease, positive HUT, presence of prodromal symptoms, physical and mental ability to perform ICM, and informed consent to participate in the study. Mean number of syncopal episodes was 2.4 ± 1.6 (median 3). From these 80 patients, 38 patients were included into study (9 men, 28 women, and mean age 35.82 ± 15.2 years). The aim of the present work was to study hemodynamic impact of different isometric counter-pressure maneuvers (ICM) in patients with recurrent vasovagal syncope and to assess their clinical efficacy.ġ55 patients with recurrent syncope underwent head-up tilt test (HUT). Published data regarding the efficacy of isometric handgrip are controversial. In general, maneuvers involving large muscle groups (whole-body tensing and leg muscle tensing) should be more efficient than maneuvers involving only smaller muscle groups (handgrip and arm tensing). The efficacy of ICM is depending on the muscular mass involved. In comparison to positional changes or dynamic muscle exercise, they draw less attention to affected persons suffering from presyncope what may be preferred in some situations.įrom published literature, it seems that some of maneuvers are more efficacious than other. They are efficient also in patients with orthostatic hypotension and improve orthostatic tolerance even in healthy persons. ICM are recommended by current guidelines for patients with recurrent vasovagal syncope because of its efficacy and simplicity. Isometric counter-pressure maneuvers (ICM) are based on the fact that isometric muscle contraction increases blood pressure. A number of small studies and one large multicenter study showed their efficacy. A different maneuvers were proposed-positional changes (lying down, bending forward, squatting, crash position, and leg crossing), dynamic muscle pumping (tiptoeing and walking), and isometric muscle tensing (arm tensing, leg tensing, isometric handgrip, and whole-body tensing). Physical countermeasures have been suggested as a first-line treatment, especially in young patients with recognizable prodromal syndromes. ICM effectively counteract the HUT-induced and spontaneous vasovagal syncope and improve quality of life.ĭifferent treatment options have been proposed in the prevention of vasovagal syncope recurrences. ICM increase blood pressure by variable hemodynamic mechanisms. Quality of life improved in all patients. ICM were able to prevent syncope in 47% of patients during HUT-induced presyncope and in 71% of patients during spontaneous presyncope. In unilateral HG, a rise in peripheral resistance was the principal mechanism. In SQ, the underlying mechanism was augmentation of stroke volume by increased venous return. In most ICM (LCMT, WBT, HeR, and TE), an increase in CO due to simultaneous increase in HR and SV was observed. The hemodynamic background of ICM was not uniform. ResultsĪll maneuvers increased mean arterial pressure. The recurrence of syncope and quality of life were also evaluated during 26 ± 7 month follow-up period. ![]() Clinical efficacy of ICM was assessed during HUT-induced presyncope. Hemodynamic parameters were recorded during ICM using photopletysmographic principle: blood pressure, heart rate, cardiac output, stroke volume, and total peripheral resistance. In 38 patients with VVS (9 men, 28 women, mean age 35.82 ± 15.2 years), following ICM were performed-squatting (SQ), leg crossing with muscle tensing (LCMT), whole-body tensing (WBT), heel raises (HeR), toe extension (TE), and unilateral handgrip (HG). The aim was to study hemodynamic mechanisms and effectiveness of ICM in prevention of head-up tilt (HUT)-induced and spontaneous VVS. Isometric counter-pressure maneuvers (ICM) were proposed as first-line treatment in patients with vasovagal syncope (VVS).
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