Improved Patient Outcomes by Normalizing Sympathovagal Balance: Differentiating Syncope—Precise Subtype Differentiation Leads to Improved Outcomes

Figure 5

Results from a 34-year-old male, non diabetic patient, with a BMI of 25.7/in², treated for labile hypertension with complaints of lightheadedness. At rest, his HR was 85 bpm, BP was 132/89, LFa was 0.58 bpm², RFa was 0.41 bpm², and SB was 1.41. At rest, he demonstrates advanced autonomic dysfunction (from the first plot on the second row, his response (point “A”) is below the grey, or normal, area due to his RFa being less than 0.5 bpm²) and PE with Valsalva (left panel of the last plot on the second row). From his trends plot (the last plot on the first row), his peak (red) S-response to stand (section “F”) is greater than one-third of that of Valsalva (section “D”), indicating an instantaneous SE, associated with (preclinial)syncope. Taken together, the SE with PE, VVS-PE is diagnosed. Treating the Vagal component and history of hypertension with Carvedilol [23] relieved both the syncopal events and the labile hypertension.