Malignant Vasovagally Mediated Hypotension and Bradycardia: A Possible Cause of Sudden Death in Young Patients with Asthma

¹ Electrophysiology Section, Divisions of Pediatric Cardiology and Cardiology, Depts of Pediatrics and Medicine and, Division of Allergy and Immunology, Dept of Pediatrics, The Medical College of Ohio, Toledo, Ohio

Asthma is a common chronic disorder affecting roughly 3% of the population of the United States and producing considerable morbidity.¹ However, despite increasing knowledge concerning the pathophysiology of this disease and an expanded therapeutic armamentarium, mortality rates from asthma have increased, particularly in younger patients.² Although some of the increase can be accounted for by under-treatment, inadequate access to care, and delays in appropriate management,³ a number of episodes of unexpected sudden death have occurred in young patients with asthma without adequate explanation.⁴

Recent literature provides evidence that severe episodes of vasovagally (autonomic) mediated hypotension and bradycardia (the malignant vasovagal syndrome) may mimic or cause sudden death episodes in young people.⁵