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Yamaguchi Y, Mizumaki K, Iwamoto J, et al. Recurrent syncope in two patients with a sigmoid-shaped interventricular septum and no left ventricular hypertrophy. J Arrhythm. 2015;31(6):391-4doi: 10.1016/j.joa.2015.04.006.
Yamaguchi, Y., Mizumaki, K., Iwamoto, J., Nishida, K., Sakamoto, T., Nakatani, Y., Kataoka, N., & Inoue, H. (2015). Recurrent syncope in two patients with a sigmoid-shaped interventricular septum and no left ventricular hypertrophy. Journal of arrhythmia, 31(6), 391-4. https://doi.org/10.1016/j.joa.2015.04.006
Yamaguchi, Yoshiaki, et al. "Recurrent syncope in two patients with a sigmoid-shaped interventricular septum and no left ventricular hypertrophy." Journal of arrhythmia vol. 31,6 (2015): 391-4. doi: https://doi.org/10.1016/j.joa.2015.04.006
Yamaguchi Y, Mizumaki K, Iwamoto J, Nishida K, Sakamoto T, Nakatani Y, Kataoka N, Inoue H. Recurrent syncope in two patients with a sigmoid-shaped interventricular septum and no left ventricular hypertrophy. J Arrhythm. 2015 Dec;31(6):391-4. doi: 10.1016/j.joa.2015.04.006. Epub 2015 May 28. PMID: 26702321; PMCID: PMC4672037.
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J Arrhythm. 2015 Dec;31(6):391-4. doi: 10.1016/j.joa.2015.04.006. Epub 2015 May 28.

Recurrent syncope in two patients with a sigmoid-shaped interventricular septum and no left ventricular hypertrophy.

Journal of arrhythmia

Yoshiaki Yamaguchi, Koichi Mizumaki, Jotaro Iwamoto, Kunihiro Nishida, Tamotsu Sakamoto, Yosuke Nakatani, Naoya Kataoka, Hiroshi Inoue

Affiliations

  1. Second Department of Internal Medicine, Graduate School of Medicine, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
  2. Clinical Research and Ethics Center, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.

PMID: 26702321 PMCID: PMC4672037 DOI: 10.1016/j.joa.2015.04.006

Abstract

Sigmoid-shaped interventricular septum (SIS) is not uncommon in elderly patients and is considered a normal part of the aging process. However, several patients have been reported to have clinical symptoms due to the narrowing of the left ventricular outflow tract (LVOT). Two patients with SIS presented with recurrent episodes of syncope after drinking or taking sublingual nitroglycerin (NG). In both patients, a head-up tilt test involving provocation with alcohol, NG, or isoproterenol induced the vasovagal reflex along with an increase in the pressure gradient between the apex and LVOT. The patients experienced no further episodes of syncope after initiating bisoprolol treatment. In patients with SIS, induction of the vasovagal reflex via an increase in left ventricular (LV) pressure due to LVOT obstruction concomitant with increased LV construction is a potentially important cause of syncope, which may be effectively prevented by beta-blockers.

Keywords: Left ventricular outflow tract obstruction; Sigmoid septum; Vasovagal reflex

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