Vasovagal Syncope

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction

Vasovagal syncope (VVS), also known as neurocardiogenic or reflex syncope, is caused by a sudden drop in blood pressure, often triggered by a reaction to something. VVS is the most common form of syncope, and although usually harmless, its frequent occurrence adversely affects quality of life and increase the risk of adverse events. Diagnosis and management of vasovagal syncope is hard as the differential diagnoses are manyfold. In most cases vasovagal syncope is treated conservatively.

Epidemiology

• VVS, the most common form of syncope in adults, is the cause of 85% of syncopal events in people younger than 40 years.
• In older persons, more than half of syncopal episodes are due to VVS. VVS needs a working autonomic nervous system its occurrence is low in those with autonomic nervous system dysfunction, eg Parkinson disease.
• Lifetime incidence a VVS is more than 33%.

Triggers

Include

• Prolonged standing
• Emotional stress
• Pain
• The sight of blood
• Fear of needles
• Time varying magnetic field, for example transcranial magnetic stimulation)

Management

VVS is on the whole treated conservatively.

• If known and avoidable, patients need to avoid triggers.
• Patients are may need to drink more fluids to improve their volume status and to slowly change positions. If the patient experiences "warning signs" of a VVS educate them to place themselves in a supine position if they feel an imminent event.
• Most patients with VVS have a history of a syncopal prodrome. Patients may describe a feeling of lightheadedness, feelings of warmth and nausea, tunnel vision, ringing in their ears, and profuse sweating.
• Preventative strategies at this stage will often prevent a VVS event by preventing traumatic risk from a fall.
• In refractory or disabling cases and cases of prolonged asystole, cardiac pacing is a therapeutic option.

Education Affected Persons

• Recognise warning symptoms and immediately:
• Sit down or lie flat when possible with legs eg on top of a pillow, or up against a wall or chair.
• Clench and unclench your fistsor squeeze the leg and buttock muscles.
• Quick action may prevent the episode.
• Get up cautiously when you feeling ok, but be prepared to sit down promptly if symptoms return.