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Correspondence
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Volume 329:1966-1967 December 23, 1993 Number 26
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Neurocardiogenic Syncope

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by Osswald, S.
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To the Editor: The Images in Clinical Medicine in the July 1 issue1 intrigued me. I am uncertain whether the hemodynamic reaction shown represents syncope mediated by the neurocardiogenic (Bezold-Jarisch) reflex or carotid-sinus hypersensitivity with only a vasodepressor component. Generally, bradycardia is expected in neurocardiogenic syncope, which is thought to be mediated by vagal afferent and efferent fibers2,3. Conversely, carotid-sinus hypersensitivity mediated by glossopharyngeal afferent fibers occurs without bradycardia in a pure vasodepressor reaction4. Given the patient's history of metastatic cancer of the neck, carotid-sinus hypersensitivity seems to be a strong candidate for having produced the illustrated hemodynamic . . . [Full Text of this Article]

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