Key result
Midodrine hydrochloride or atropine, but not a beta blocker, prevented tilt-induced hypotension and bradycardia in a patient with vasovagal syncope and convulsions.
Why the study?
Does midodrine hydrochloride prevent tilt-induced hypotension and bradycardia in a patient with vasovagal syncope?
Case Report (n=1)
Does midodrine hydrochloride prevent tilt-induced hypotension and bradycardia in a patient with vasovagal syncope?
Midodrine hydrochloride may be effective in preventing tilt-induced hypotension and bradycardia in patients with vasovagal syncope where beta blockers fail.
May support midodrine or atropine when beta blockers fail; hypothesis-generating case report requiring randomized confirmation.
A 42-year-old female had suffered from repeated syncope. She had vasovagal syncope with convulsions from vasodilatation and cardiac standstill which lasted for 9.8 sec. The 60 degrees head-up tilt test, nitroglycerin injection and isoproterenol infusion provoked vasovagal reaction. Although a beta blocker was not effective in preventing tilt-induced hypotension and bradycardia, midodrine hydrochloride (alpha-1 stimulant) or atropine prevented it. In this patient, insufficient constriction of capacitance vessels might have played an important role in activation of an inhibitory reflex from cardiopulmonary mechanoreceptors which caused hypotension and bradycardia.
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Koyama et al. (1992) conducted a case report in Vasovagal syncope with convulsions (n=1). Midodrine hydrochloride vs. Beta blocker was evaluated on Prevention of tilt-induced hypotension and bradycardia. Midodrine hydrochloride or atropine, but not a beta blocker, prevented tilt-induced hypotension and bradycardia in a patient with vasovagal syncope and convulsions.
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