Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 15;17(3):427.
doi: 10.3390/v17030427.

A New Approach to the Etiology of Syncope: Infection as a Cause

Branislav Milovanovic  1   2 , Nikola Markovic  1 , Masa Petrovic  1   2 , Vasko Zugic  1   2 , Milijana Ostojic  1 , Milica Dragicevic-Antonic  1 , Milovan Bojic  1   2
Affiliations

A New Approach to the Etiology of Syncope: Infection as a Cause

Branislav Milovanovic et al. Viruses. .

Abstract

Background/objectives: Syncope is a common clinical occurrence, with neurally mediated and orthostatic types accounting for about 75% of cases. The exact pathophysiological mechanisms remain unclear, with recent evidence suggesting autonomic nervous system damage and a potential infectious etiology. This study aimed to examine the role of infection in the development of syncope and orthostatic hypotension (OH).

Methods: The cross-sectional study included 806 patients from the Neurocardiological Laboratory of the Institute for Cardiovascular Diseases "Dedinje". Patients were divided into three groups: unexplained recurrent syncope (n = 506), syncope with OH during the head-up tilt test (HUTT) (n = 235), and OH without a history of syncope (n = 62). All participants underwent the HUTT, and 495 underwent serological testing for various microorganisms. Data were analyzed using chi-squared tests and binary and multinomial logistic regression.

Results: The HUTT was positive in 90.6% of patients with syncope and OH, compared with 61.6% with syncope alone (p < 0.001). Serological testing revealed that 57.85% of syncope patients, 62.9% of syncope with OH patients, and 78% of OH patients had positive IgM antibodies to at least one microorganism. Multivariate analysis indicated that IgM antibodies to Coxsackievirus and Epstein-Barr virus were significant predictors of OH.

Conclusions: This study demonstrated a potential association between infections and syncope/OH. Further investigation into the role of infectious agents in autonomic dysfunction is warranted to clarify the underlying mechanisms of syncope and OH.

Keywords: autonomic dysfunction; head-up tilt test; neurocardiology; syncope.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Positive IgM antibodies for group 1.
Figure 2
Figure 2
Positive IgM antibodies for group 2.
Figure 3
Figure 3
Positive IgM antibodies for group 3.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Brignole M., Moya A., De Lange F.J., Deharo J.C., Elliott P.M., Fanciulli A., Fedorowski A., Furlan R., Kenny R.A., Martiın A. 2018 ESC guidelines for the diagnosis and management of syncope. Eur. Heart J. 2018;39:1883–1948. doi: 10.1093/eurheartj/ehy037. - DOI - PubMed
    1. Sutton R. Reflex syncope: Diagnosis and treatment. J. Arrhythmia. 2017;33:546. doi: 10.1016/j.joa.2017.03.007. - DOI - PMC - PubMed
    1. Xiong L., Leung T.W.H. Autonomic dysfunction in neurological disorders. Aging. 2019;11:1903–1904. doi: 10.18632/aging.101896. - DOI - PMC - PubMed
    1. Yu T.Y., Lee M.K. Autonomic dysfunction, diabetes and metabolic syndrome. J. Diabetes Investig. 2021;12:2108–2111. doi: 10.1111/jdi.13691. - DOI - PMC - PubMed
    1. Salman I.M. Cardiovascular Autonomic Dysfunction in Chronic Kidney Disease: A Comprehensive Review. Curr. Hypertens. Rep. 2015;17:59. doi: 10.1007/s11906-015-0571-z. - DOI - PubMed

Publication types

LinkOut - more resources