{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:47:12Z","timestamp":1755794832183,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"unspecified","delay-in-days":114,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Mona Taliaferro"},{"name":"FBRI","award":["2022A018462"],"award-info":[{"award-number":["2022A018462"]}]},{"DOI":"10.13039\/100000050","name":"The National Heart, Lung and Blood Institute","doi-asserted-by":"crossref","award":["1OT2HL156812-01"],"award-info":[{"award-number":["1OT2HL156812-01"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,4,7]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To characterise the haemodynamic profile of supine reflex syncope triggered by a needle insertion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective study evaluated consecutive patients with orthostatic intolerance who completed autonomic testing at Brigham and Women\u2019s Faulkner Hospital between 2016 and 2024 and developed supine syncope induced by needle insertion. Tests included deep breathing, Valsalva manoeuvre, head-up tilt and skin biopsies for small fibre quantification. We continuously recorded cerebral blood flow velocity from the middle cerebral artery using transcranial Doppler, along with end-tidal CO<jats:sub>2<\/jats:sub>, ECG and beat-to-beat blood pressure. The skin at the leg was anaesthetised with 0.5\u2009mL of 1% lidocaine for biopsy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The needle insertion triggered syncope in five out of 4876 (0.1%) patients. Following a latency of 56\u2009s, participants reported typical symptoms of cerebral hypoperfusion (light-headedness, visual change, dyspnoea) that culminated in a brief loss of consciousness. These symptoms were accompanied by a progressive decrease in heart rate, blood pressure, mean cerebral blood flow velocity, hyperventilation and widening of the transcranial signal (systolic-diastolic difference). Syncope type was mixed into two, cardioinhibition without asystole in one and cardioinhibition with asystole in two patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Supine syncope triggered by a needle insertion is associated with cardioinhibitory (characterised by bradycardia), vasodepressor (characterised by vasodilatory hypotension) and cerebral arteriolar vasodilatory (characterised by transcranial signal widening) responses.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003201","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T01:35:20Z","timestamp":1745544920000},"page":"e003201","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Supine syncope induced by needle insertion"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5971-1208","authenticated-orcid":false,"given":"Peter","family":"Novak","sequence":"first","affiliation":[{"name":"Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"Novak","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"2025081612090382000_12.1.e003201.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy037"},{"key":"2025081612090382000_12.1.e003201.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.11.023"},{"key":"2025081612090382000_12.1.e003201.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.3723.873"},{"key":"2025081612090382000_12.1.e003201.4","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.joms.2005.05.320","article-title":"Safety of Intravenous Sedation Administered by the Operating Oral Surgeon: The First 7 Years of Office Practice","volume":"63","author":"Rodgers","year":"2005","journal-title":"J Oral Maxillofac Surg"},{"key":"2025081612090382000_12.1.e003201.5","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s10286-017-0443-5","article-title":"Can syncope cause convulsive seizures in adults?","volume":"27","author":"Kelly","year":"2017","journal-title":"Clin Auton Res"},{"key":"2025081612090382000_12.1.e003201.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.joa.2017.03.007"},{"key":"2025081612090382000_12.1.e003201.7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1684\/j.1950-6945.2001.tb00457.x","article-title":"Anoxic seizures: self\u2010terminating syncopes","volume":"3","author":"Stephenson","year":"2001","journal-title":"Epileptic Disord"},{"key":"2025081612090382000_12.1.e003201.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2014.05.003"},{"key":"2025081612090382000_12.1.e003201.9","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1001\/jamainternmed.2015.0945","article-title":"Unnecessary hospitalization and related harm for patients with low-risk syncope","volume":"175","author":"Canzoniero","year":"2015","journal-title":"JAMA Intern Med"},{"key":"2025081612090382000_12.1.e003201.10","doi-asserted-by":"publisher","DOI":"10.1111\/papr.12440"},{"key":"2025081612090382000_12.1.e003201.11","doi-asserted-by":"crossref","unstructured":"Novak P . Autonomic Testing. 1st edn. New York, NY: Oxford University Press, 2019.","DOI":"10.1093\/med\/9780190889227.001.0001"},{"key":"2025081612090382000_12.1.e003201.12","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00637.2013"},{"key":"2025081612090382000_12.1.e003201.13","doi-asserted-by":"crossref","DOI":"10.1161\/01.CIR.0000031829.09784.82","article-title":"Cerebral vasoconstriction in vasovagal syncope: any link with symptoms? A transcranial Doppler study","volume":"106","author":"Carey","year":"2002","journal-title":"Circulation"},{"key":"2025081612090382000_12.1.e003201.14","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199408000-00015"},{"key":"2025081612090382000_12.1.e003201.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)62272-1"},{"key":"2025081612090382000_12.1.e003201.16","doi-asserted-by":"crossref","DOI":"10.1212\/CPJ.0000000000200463","article-title":"Role of Central Sensitization Syndrome in Patients With Autonomic Symptoms","volume":"15","author":"Novak","year":"2025","journal-title":"Neurol Clin Pract"},{"key":"2025081612090382000_12.1.e003201.17","doi-asserted-by":"crossref","first-page":"2630","DOI":"10.1093\/brain\/awp179","article-title":"Symptoms and signs of syncope: a review of the link between physiology and clinical clues","volume":"132","author":"Wieling","year":"2009","journal-title":"Brain (Bacau)"},{"key":"2025081612090382000_12.1.e003201.18","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2024.1476918","article-title":"Orthostatic intolerance with tachycardia (postural tachycardia syndrome) and without (hypocapnic cerebral hypoperfusion) represent a spectrum of the same disorder","volume":"15","author":"Novak","year":"2024","journal-title":"Front Neurol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T19:09:17Z","timestamp":1755371357000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,4,24]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/openhrt-2025-003201"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003201","relation":{},"ISSN":["2053-3624"],"issn-type":[{"type":"electronic","value":"2053-3624"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}