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  • Title: Recurrent supine syncope: an unusual manifestation of the neurally mediated faint.
    Author: Iskos D, Shultz JJ, Benditt DG.
    Journal: J Cardiovasc Electrophysiol; 1998 Apr; 9(4):441-4. PubMed ID: 9581960.
    Abstract:
    INTRODUCTION: Syncope occasionally may occur in the supine patient due to severe brady- or tachyarrhythmia. However, recurrent syncope upon assumption of the supine position as a result of a neurally mediated reflex mechanism has not been reported previously. METHODS AND RESULTS: Two young patients, both of whom had significant systemic illnesses, experienced recurrent episodes of presyncope and/or syncope shortly after assuming the supine position. During ambulatory ECG monitoring, symptoms were provoked only by lying down and were associated with transient bradycardia. Head-up tilt table testing was undertaken as part of the syncope evaluation and was nondiagnostic in both cases. However, both patients exhibited a transient cardioinhibitory response with reproduction of typical symptoms upon return of the table to the supine position ("reverse tilt"). During follow-up (8 and 14 months), both patients improved with pharmacologic treatment (disopyramide in one case and midodrine in the other). CONCLUSION: Presyncope or syncope upon lying down can be an unusual manifestation of the neurally mediated faint.
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