Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case–control study

EP Europace, Feb 2015

Anxiety is an emotion, which stimulates sympathetic nervous outflow potentially facilitating vasovagal reflex syncope (VVS) but reports on anxiety levels in patients with VVS are sparse.

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Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case–control study

Europace Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case - control study D. Zys´ko 2 M. Szewczuk-Bogusławska 1 M. Kaczmarek 0 A.K. Agrawal 6 J. Rudnicki 5 J. Gajek 4 O. Melander 3 R. Sutton 8 A. Fedorowski 3 7 0 Center of Neuropsychiatry 'Neuromed' , Białowieska 74A, Wroclaw 54-235 , Poland 1 Department of Psychiatry, Wroclaw Medical University , Wroclaw 50-367 , Poland 2 Department of Emergency Medicine, Wroclaw Medical University , Wroclaw 51-618 , Poland 3 Department of Clinical Sciences, Lund University, Clinical Research Center, Ska ̊ne University Hospital , Malmo ̈ 205-02 , Sweden 4 Department of Cardiology, Wroclaw Medical University , Wroclaw 50-556 , Poland 5 Department of Minimally Invasive Surgery and Proctology, Wroclaw Medical University , Wroclaw 50-556 , Poland 6 2nd Department of General and Oncological Surgery, Wroclaw Medical University , Wroclaw 50-556 , Poland 7 Arrhythmia Department, Ska ̊ne University Hospital , Malmo ̈ 205-02 , Sweden 8 National Heart and Lung Institute, Imperial College, St Mary's Hospital Campus , 59-61 North Wharf Road, London W2 1LA , UK Aims Anxiety is an emotion, which stimulates sympathetic nervous outflow potentially facilitating vasovagal reflex syncope (VVS) but reports on anxiety levels in patients with VVS are sparse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods We studied anxiety levels in young women (21 - 40 years) referred for unexplained transient loss of consciousness and results (TLOC), and age-matched female controls with or without past history of TLOC (≈ probable VVS). Referred patients underwent head-up tilt (HUT) according to current ESC Guidelines. State and Trait Anxiety Inventory questionnaire evaluated anxiety levels plus a questionnaire explored risk factors for cardiovascular disease (CVD). Sixty-five of 91 women were diagnosed with VVS on HUT. Among 549 controls, 223 (40.6%) reported at least one episode of TLOC. State-anxiety level in patients with VVS undergoing HUT (42.4 + 9.3) was higher compared with both controls with (38.3 + 10.2; P , 0.01) and without past TLOC history (35.9 + 9.8; P , 0.001). Trait anxiety in patients with VVS (42.7 + 8.4), and controls with TLOC history (42.4 + 8.4) was higher compared with controls without TLOC history (39.7 + 8.5; P , 0.01). In the logistic regression using controls without TLOC as reference, both VVS diagnosis and past history of TLOC were associated with family history of CVD [odds ratio (OR) 2.4, 95% confidence interval (CI), 1.3 - 4.4; P ¼ 0.007, and 2.3, 1.4 - 3.6; P ¼ 0.001, respectively], and this association was independent of anxiety level. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusions Trait anxiety and family history of CVD are increased in both young women with VVS and controls with history of TLOC. However, the height of anxiety level does not explain CVD heredity and other mechanisms may link syncope with CVD. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Introduction Syncope is a transient, self-limited loss of consciousness caused by global cerebral hypoperfusion.1 The most common mechanism of syncope is vasovagal reflex being responsible for 60 – 70% of all syncope.2,3 The pathophysiology of vasovagal reflex is still elusive; however, exaggerated adrenergic activation has been suggested as a trigger in susceptible individuals.4,5 In parallel, the important role of psychological factors in triggering the vasovagal reflex indicates involvement of higher brain functions such as emotions in reflex activation.6 Anxiety is an emotion, which strongly stimulates sympathetic nervous outflow and facilitates or even triggers the vasovagal reflex,7 – 10 whereas relief from anxiety by simple reassurance may significantly decrease the incidence of vasovagal attacks.1,11 – 13 According to Spielberger et al., anxiety may be assessed as the current level of fear (state anxiety) or the continuous average level of fear (trait anxiety).14 State anxiety relates to the moment of assessment and refers to how a person is feeling at the time. Trait (...truncated)


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Zyśko, D., Szewczuk-Bogusławska, M., Kaczmarek, M., Agrawal, A.K., Rudnicki, J., Gajek, J., Melander, O., Sutton, R., Fedorowski, A.. Reflex syncope, anxiety level, and family history of cardiovascular disease in young women: case–control study, EP Europace, 2015, pp. 309-313, Volume 17, Issue 2, DOI: 10.1093/europace/euu200