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Reflex syncope in classic Greek literature
AUTNEU-01765; No of Page 1 Autonomic Neuroscience: Basic and Clinical xxx (2015) xxx
Contents lists available at ScienceDirect
Autonomic Neuroscience: Basic and Clinical journal homepage: www.elsevier.com/locate/autneu
Reflex syncope in classic Greek literature Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery. It may be preceded by prodromal symptoms and signs (Task Force for the Diagnosis and Management of Syncope et al., 2009). The prodrome of syncope not followed by loss of consciousness is known as pre-syncope. Reflex syncope is the most common form of syncope. It is due to an inappropriate response of cardiovascular reflexes to emotional, situational or orthostatic distress and it is usually preceded by prodromal symptoms and signs of autonomic activation as sweating, pallor, nausea, etc. (Task Force for the Diagnosis and Management of Syncope et al., 2009). Some cases of reflex syncope are accurately described in literary masterpieces. Heaton (2006) reported 18 cases of syncope due to strong emotion in Shakespeare's poems. We have already described two emotional stress-mediated syncopal episodes in “Divina Comedia” (Perciaccante and Coralli, 2014). At our knowledge, in this paper, we report the oldest literary descriptions of reflex-syncope and pre-syncope in two major works of the ancient Greek literature. In “Odyssey” – book 24 – , Homer describes an interesting syncopal episode due to a strong emotional stress. When Laerte recognized his son Ulysses “his knees were loosened where he stood and his heart melted…about his dear son, he flung both his arms and the much-enduring and goodly Odysseus caught him unto him fainting. But when he revived and his spirit returned again into his breast, once more he made answer and spoke…” (Omero, 2014). Syncope is characterized by a rapid onset and a spontaneous complete recovery. Indeed, when Laerte revived, he starts again immediately to talk with Ulysses. An interesting report of pre- syncope is described in one of the most famous odes of Sappho (ca. 500 B.C.) known as “Ode to a loved one” or “Ode of jealousy”. The emotion due to the vision of beloved woman
induces Sappho to say that: “tongue breaks and thin fire is racing under skin and in eyes no sight and drumming fill ears and cold sweat holds me and shaking grips me all, greener than grass. I am dead or almost I seem to me” (Anacreon and De Rogati, 2010). In this exciting ode, Sappho provides one of the most ancient, poetic and clear description of prodromes of vasovagal syncope as sweating, blurred vision, feeling of warmth and tinnitus. References Anacreon, Sappho, De Rogati, F.S., 2010. Le Odi Di Anacreonte E Di Saffo. Nabu Press, Italy. Heaton, K.W., 2006. Faints, fits and fatalities from emotion in Shakespeare's characters: survey on canon. BMJ 333 (7582), 1335–1338 (Dec 23). Omero, 2014. Odissea. Giulio Einaudi Editore, Italy. Perciaccante, A., Coralli, A., 2014. Dante's syncopes. Sleep Med. 15 (2), 276 (Feb). Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), Heart Rhythm Society (HRS)Moya, A., Sutton, R., Ammirati, F., Blanc, J.J., Brignole, M., Dahm, J.B., Deharo, J.C., Gajek, J., Gjesdal, K., Krahn, A., Massin, M., Pepi, M., Pezawas, T., Ruiz Granell, R., Sarasin, F., Ungar, A., van Dijk, J.G., Walma, E.P., Wieling, W., 2009. Guidelines for the diagnosis and management of syncope (version 2009). Eur. Heart J. 30 (21), 2631–2671 (Nov).
A. Perciaccante Department of Medicine, San Giovanni di Dio Hospital, Gorizia, Italy Corresponding author at: Department of Medicine, San Giovanni di Dio, via Fatebenefratelli, 34, 34170 Gorizia, Italy. Tel.: +39 0481592069; fax: +39 0481594510. E-mail address: [email protected]. A. Coralli Department of Medicine, San Giovanni Decollato, Andosilla Hospital, Civita Castellana, Italy 12 May 2015 Available online xxxx
http://dx.doi.org/10.1016/j.autneu.2015.05.007 1566-0702/© 2015 Elsevier B.V. All rights reserved.
Please cite this article as: Perciaccante, A., Coralli, A., Reflex syncope in classic Greek literature, Auton. Neurosci. (2015), http://dx.doi.org/10.1016/ j.autneu.2015.05.007
Contents lists available at ScienceDirect
Autonomic Neuroscience: Basic and Clinical journal homepage: www.elsevier.com/locate/autneu
Reflex syncope in classic Greek literature Syncope is a transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery. It may be preceded by prodromal symptoms and signs (Task Force for the Diagnosis and Management of Syncope et al., 2009). The prodrome of syncope not followed by loss of consciousness is known as pre-syncope. Reflex syncope is the most common form of syncope. It is due to an inappropriate response of cardiovascular reflexes to emotional, situational or orthostatic distress and it is usually preceded by prodromal symptoms and signs of autonomic activation as sweating, pallor, nausea, etc. (Task Force for the Diagnosis and Management of Syncope et al., 2009). Some cases of reflex syncope are accurately described in literary masterpieces. Heaton (2006) reported 18 cases of syncope due to strong emotion in Shakespeare's poems. We have already described two emotional stress-mediated syncopal episodes in “Divina Comedia” (Perciaccante and Coralli, 2014). At our knowledge, in this paper, we report the oldest literary descriptions of reflex-syncope and pre-syncope in two major works of the ancient Greek literature. In “Odyssey” – book 24 – , Homer describes an interesting syncopal episode due to a strong emotional stress. When Laerte recognized his son Ulysses “his knees were loosened where he stood and his heart melted…about his dear son, he flung both his arms and the much-enduring and goodly Odysseus caught him unto him fainting. But when he revived and his spirit returned again into his breast, once more he made answer and spoke…” (Omero, 2014). Syncope is characterized by a rapid onset and a spontaneous complete recovery. Indeed, when Laerte revived, he starts again immediately to talk with Ulysses. An interesting report of pre- syncope is described in one of the most famous odes of Sappho (ca. 500 B.C.) known as “Ode to a loved one” or “Ode of jealousy”. The emotion due to the vision of beloved woman
induces Sappho to say that: “tongue breaks and thin fire is racing under skin and in eyes no sight and drumming fill ears and cold sweat holds me and shaking grips me all, greener than grass. I am dead or almost I seem to me” (Anacreon and De Rogati, 2010). In this exciting ode, Sappho provides one of the most ancient, poetic and clear description of prodromes of vasovagal syncope as sweating, blurred vision, feeling of warmth and tinnitus. References Anacreon, Sappho, De Rogati, F.S., 2010. Le Odi Di Anacreonte E Di Saffo. Nabu Press, Italy. Heaton, K.W., 2006. Faints, fits and fatalities from emotion in Shakespeare's characters: survey on canon. BMJ 333 (7582), 1335–1338 (Dec 23). Omero, 2014. Odissea. Giulio Einaudi Editore, Italy. Perciaccante, A., Coralli, A., 2014. Dante's syncopes. Sleep Med. 15 (2), 276 (Feb). Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), Heart Rhythm Society (HRS)Moya, A., Sutton, R., Ammirati, F., Blanc, J.J., Brignole, M., Dahm, J.B., Deharo, J.C., Gajek, J., Gjesdal, K., Krahn, A., Massin, M., Pepi, M., Pezawas, T., Ruiz Granell, R., Sarasin, F., Ungar, A., van Dijk, J.G., Walma, E.P., Wieling, W., 2009. Guidelines for the diagnosis and management of syncope (version 2009). Eur. Heart J. 30 (21), 2631–2671 (Nov).
A. Perciaccante Department of Medicine, San Giovanni di Dio Hospital, Gorizia, Italy Corresponding author at: Department of Medicine, San Giovanni di Dio, via Fatebenefratelli, 34, 34170 Gorizia, Italy. Tel.: +39 0481592069; fax: +39 0481594510. E-mail address: [email protected]. A. Coralli Department of Medicine, San Giovanni Decollato, Andosilla Hospital, Civita Castellana, Italy 12 May 2015 Available online xxxx
http://dx.doi.org/10.1016/j.autneu.2015.05.007 1566-0702/© 2015 Elsevier B.V. All rights reserved.
Please cite this article as: Perciaccante, A., Coralli, A., Reflex syncope in classic Greek literature, Auton. Neurosci. (2015), http://dx.doi.org/10.1016/ j.autneu.2015.05.007