What is a Vasovagal Syncope?

Vasovagal syncopeDefinition of syncope

Syncope is a transient loss of consciousness caused by a decrease in cerebral blood flow of short duration (from a few seconds to a few minutes). Before syncope, patient may feel dizziness, but loss of consciousness is usually relatively sudden.

 

Vasovagal syncope

The person suffering syncope typically collapse and fall to the ground. There are many possible causes for syncope, but the most common is called "vasovagal syncope", that is a simple fainting, not caused by illness, so it is always benign.

The vasovagal syncope is relatively common in the general population, suffering it up to 20% of people over their lifetime. Furthermore, in 35% of them is repeated at least once.

 

Cause of vasovagal syncope

The vasovagal syncope is due to the triggering of a reflex response that causes bradycardia (slow heart rate) and / or vasodilation (hypotension). This reflex response is called "neurocardiogenic reflex", which exists in all people, because it participates in the regulation of heart rate and blood pressure, but in certain individuals is triggered by low intensity stimuli, causing syncope.

It is known that some people lose consciousness when seeing blood or surgery, when prodded for blood draws, perceiving unpleasant odors, standing for long periods, or in situations of emotional stress. All these are examples of "neuroreflex syncope".

Sometimes syncope occurs after the unpleasant situation, when the patient is relaxed and calm, then triggering the neurocardiogenic reflex. There is, however, unusual vasovagal syncope, which appear abruptly with no obvious trigger.

 

 

Diagnosis of vasovagal syncope

The diagnosis of vasovagal syncope is easier if there is a clear trigger, such as fear, pain, emotion, disgust, medical examination or after being long standing. In these cases, it does not require further studies.

However, when the trigger is not obvious, it is convenient to perform some diagnostic tests, mainly an electrocardiogram, echocardiogram, and Holter monitoring to rule out heart disease such as cardiomyopathy, valve disease, and arrhythmias. In some patients it is necessary to trigger syncope under surveillance, to discover the cardiovascular response that causes it, using a test called "tilt table test".

Vasovagal syncope

 

Treatment of vasovagal syncope

Vasovagal syncope treatment should begin by explaining to the patient of the benign nature of the problem. The sufferer should stay calm, because it is unimportant. When the vasovagal syncope has occurred for the first time it should not be considered as a disease and does not require any treatment.

However, if syncope repeats, especially if it is common and significantly alter the quality of life of patients, it requires treatment and regular monitoring. In that case, you should always ask a cardiologist with experience in this pathology.

The first-line treatment is based on a number of general recommendations to increase cerebral blood flow. It is advisable to drink plenty of fluids, usually about 2 liters of water a day, and eat salt. Avoid standing for long periods of time without moving; while standing, it is good to perform contraction movements of the legs; when sitting down, legs must be kept elevated whenever possible and do not cross them.

In some people it is useful "orthostatic training", which consists of daily 30-40 minute sessions of upright standing with their upper back against a vertical wall and with their feet planted 15 cm away from the wall, without moving. In the vicinity must be placed a mat or bed to lie down if dizziness occurs.

It is also recommended to sleep with the head of the bed slightly raised, to allow exposure to gravity during sleep and prevent the abrupt change to get up in the morning. In some people are effective the compression stockings from the feet to the waist.

Finally, if all this is not enough, prevention of syncope should be attempted with medication, which unfortunately is not effective in all cases. It has been tested with different drugs with widely varying results. It should always be the cardiologist whom make the indication of the most suitable medication for each person.

If vasovagal syncope is repetitive and is preceded by symptoms, the patient should also know some methods which try to abort the crisis and avoid losing consciousness. If you start to feel dizziness or generalized weakness, or other premonitory symptoms, the most effective is to lie down and elevate your legs, as this increases brain flow immediately.

As the intention is always to derive the blood to the head, is also useful leg-crossing with lower body tensing, squatting, and hand/arm-tensing. Finally, if the patient loses consciousness, accompanying people should place them on the floor, to elevate their legs, and wait for full recovery, which usually takes only a few minutes.

When a person suffers a fainting on the street or in a public establishment, is frequent that other persons lift them immediately. This is a serious mistake because when they are lifted, further reducing the flow to the head, the loss of consciousness continues.

Although there have been many studies, the truly useful advances in the treatment of vasovagal syncope have been scarce. The first step in diagnosing a patient with syncope is to evaluate whether the loss of consciousness was due to a serious arrhythmia. Once excluded this possibility and diagnosed as vasovagal syncope, treatment is difficult because it has not found a truly effective remedy.

Several studies have shown that the education of patients, so that they know exactly what is the vasovagal syncope and apply the physical measures to prevent the loss of consciousness, is the most effective method to treat the problem. The drugs are less effective, but may be useful in some cases. The pacemaker is necessary in a few patients. Ablation is in process of investigation.

Therapeutic measures of vasovagal syncope remain very limited and there is no truly effective treatment. The advances in its treatment are few and they are coming out very slowly in spite of the extensive investigation on this subject.

 

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