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Figure 2 Case patient. From top to bottom are shown heart rate (HR) curve and blood pressure (BP) curves (systolic and diastolic). The arrows indicate the passage from supine to standing and vice versa. (Left panel) Inactive sham treatment. There is an absence of adaptation of blood pressure to the upright position. Blood pressure progressively declines throughout the test; after 8 min there is a sudden decrease in blood pressure. After an initial slight increase, heart rate also declines. The patient becomes syncopal. The decrease in heart rate in association with blood pressure decrease suggests a late activation of a vagal reflex, which is triggered by the initial dysautonomia. Thus the mechanism producing reflex syncope seems to be different from that of the typical vasovagal reaction usually observed in younger subjects. (Right panel) Active treatment. There is a slight decrease in all parameters after standing, then they stabilize all along the treatment period.
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