7' 1 2010


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:KEY WORDS

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Syncope, Vaso-vagal, Head-Up Tilt-Table Test

,
, [ .]2 ,1 "
( ) 1907
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[ .]3 1932

, [ .]4"
( )Neurally Mediated Syncope
. , (
)1 66
[.]5
27
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[ .]1
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.
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[ .]7-5
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".

"
. , 47 31 ,
.]2[ 15
[ .]2 Ganzeboom'
(
39 ,)21 "
[ .]8 ,
[ .]9 ,8
,
[ .]2 "
:
.
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,
[.]8 ,7

27

:1

( ) []21

( )
()Carotid Sinus
( , , )

Neuralgia Glossopharyngeal Trigeminal
( )Post-Prandial ,

(
, )
( , ,,
" )
(Familial
)Disautonomia, Multiple System Atrophy
( .
)

Sinus Node

Supraventricular and Ventricular Tachycardias
(Long QT Syndrome, Brugada Syndrome, Short
)QT,,arrhythmogenic Right Ventricular Dysplasia

()Myxoma
()

( )
"" ()Vascular Steal Syndromes

28

" .
( )

[ ,]10 , [.]11
,

(
, ) .
, ,
" ' ()Benzold-Jarisch Reflex
[ .]10
, ,
, ",
,Tilt-Test ,
( )Epinephrine ( )Renin ,
()
[ .]12
[ ,]13
( ,]14[ )Myocardial Contractility
( ,)Norepinephrine ( )Endothelin [.]12
[]15
(.]16[ )Vasopressin

7' 1 2010

" " [:]17

- VASIS
:Modified VASIS Classification
- Type 1 mixed
40 , 40
,
.
.
- Type 2A Cardioinhibition Without Asystole
40 ,
.
.
- Type 2B Cardioinhibition With Asystole
.
.
- Type 3 Vasodepressor
.
Bringole' [ ]17
"
( :)2
( - )Classic Vasovagal
(GTN - Glyceryl
,)Trinitrate
/
. .
(Dysautonomic
- )Vasovagal
- ,

.GTN .
(- )Orthostatic Intolerance

,

.
"

,
,

[ .]18
,
[.]18

,
, , , ,
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(Angiotensin-
,)Converting Enzyme [ACE] Inhibitors ,

7' 1 2010

:2

(")
"

"

80"

.
10" ( )

, "

Pulse Pressure

80-70"

.

, ,

Pulse Pressure

[.]19

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[ .]18 ,
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[ .]20 "
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[ .]22
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" , 85-50 [.]18
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[.]1

, 95% ,48%
97 [ .]24
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( ).

, .
-
, ()EEG
, [.]1
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100 .
89% 91%
( .)3

. -
,
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.
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( )Tilt Test
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29

7' 1 2010

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?Bifascicular Block

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3.3 35
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-2

5.5
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6.6 ?

7 .7
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30

.
."
,

[ .]2 70-60
" ,
[ .]26 74%-67%
[ .]27 30-20
400 g )Glyceryl Trinitrate( GTN
[ .]2
45-30 ,
[.]18

" " ( Isosorbid
,)Dinitrate ( ,)Isoproterenol
( ,)Clomipramine ( )Edrophonium [ .]18

( )Positivity Rate 85%
( 23
) [ .]28
,

.
," .
,

( .)Sick Sinus Syndrome

,
, .
. ,
[ .]2"
[.]2

"

. ,

[ .]2" [.]7

,

,
()Triggers
[ .]2
"
, , ,
( ,)Squatting (
.]18[ )1

[ .]21
" [.]29

[ .]30
,
[.]31
( )Tilt Training
( ,)Orthostatic Training
, " (
.]32[ )1
.
"
" ,
( )Standing Training
12-10 .
,
40-30 [.]21


[ .]34 ,33
46 " ,' '

.

[.]34


.
,ACE ,
. "
[.]35
,
[]37 ,36

7' 1 2010

. ,
, )Prevention of Syncope Trial( POST 208
( )Metoprolol
( ,)42
( .]37[ )42
( )Fludrocortisone
,
. ,
.
,
[ .]38
, ( 33 ) ,
, ,
, , [.]39
( ,)Midodrine ,
[.]40
( )Pro - Drug
( )Desglymidodrine
, ,
[ .]21
,
" , " ( )Piloerection
[.]41
" (
) (Serotonin
,Etilefrine ,Disopyramide ,)Selective Reuptake Inhibitors
Theophylline .]18[ Scopolamine
,
,Paroxetine .]18[ SSRIs


( ,)Carotid Sinus Syndrome
. "
.
( )
[ ,]21
, [.]2

. ,
,DDDR ( )Contractility ,
,DDI
[ .]42

[ .]43
()Asystolic Pauses
[.]21

3,877
, 9.8( 380)
[ .]44

:1

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'

' , ( )Squatting .
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( 15" ) .
.

. , .
, , -
30-20 . 20
.
.]21[ Elsevier
;Benditt DG., Nguyen JT., Syncope: therapeutic approaches. J Am Coll Cardiol, 2009; 12
53 (19): 1741-1751.

37
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,

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