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

Figure 6

Clinical autonomic study results from a 36 year-old-male diagnosed with posttraumatic stress disorder and hypertension, with a BMI of 54.2/in², and tilt-positive for vasovagal syncope. At rest, his HR was 75 bpm, BP was 147/94 mmHg, LFa was 2.34 bpm², RFa = 0.26 bpm², and SB was 9.16. At rest, he demonstrates advanced autonomic dysfunction (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 and stand (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 (preclinical) syncope. Taken together, the SE with PE, VVS-PE is diagnosed. Treating the vagal component with the hypertension with carvedilol [23] prevented syncope and reduced his resting BP.