Cardioinhibitory and vasodepressor responses to different stressors on head-up tilt

We describe the case of a 37-year-old man with a history of laughter-induced syncope, which caused him to crash his car. The patient was a non-smoker with a history of obstructive sleep apnoea and obesity with a body mass index of 33.5. He underwent head up tilt testing with glyceryl trinitrate provocation. On four occasions, the patient was asked to laugh which all ended in a spontaneous vigorous cough after which he started to feel lightheaded. There was concordant drop in systolic BP without any decrease in heart rate (PanelA). At 32  min, there was sinus arrest for 12 seconds and loss of consciousness for 40 seconds (PanelB). This is consistent with a diagnosis of VASIS 2B (cardioinhibitory) vasovagal syncope. However, the more relevant clinical diagnosis was cough/laughter-induced syncope, which had a vasodepressor response.
Source: Europace - Category: Cardiology Source Type: research