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(Hypertension. 1997;30:1072-1077.)
© 1997 American Heart Association, Inc.

Articles

Malignant Vagotonia Due to Selective Baroreflex Failure

Jens Jordan; John R. Shannon; Bonnie K. Black; Fernando Costa; Andrew C. Ertl; Raffaello Furlan; Italo Biaggioni; David Robertson

From the Autonomic Dysfunction Center (J.J., J.R.S., B.K.B., F.C., A.C.E., I.B., D.R.), Vanderbilt University, Nashville, Tenn; and Centro Ricerche Cardiovasculare (R.F.), Medicina Interna II, Università di Milano, Milano, Italy.

Abstract Baroreflex failure is characterized by dramatic fluctuations of sympathetic activity and paroxysms of hypertension and tachycardia. In contrast, unopposed parasympathetic activity has not been described in patients with baroreflex failure because of concurrent parasympathetic denervation of the heart. We describe the unusual case of a patient with baroreflex failure in a setting of preserved parasympathetic control of HR manifesting episodes of severe bradycardia and asystole. Thus, parasympathetic control of the HR may be intact in occasional patients with baroreflex failure. Patients with this selective baroreflex failure require a unique therapeutic strategy for the control of disease manifestations.

Key Words: baroreflex • hypotension • bradycardia • autonomic nervous system

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