Vasovagal syncope

Vasovagal syncope

Description, Causes and Risk Factors:

ICD-10: R55

Alternative Name: Vasodepressor syncope, neurally mediated syncope, neurocardiogenic syncope, postural orthostatic tachycardia syndrome (POTS), dysautonomia.

Vasovagal syncope is most commonly discovered in adolescents and in older adults. It is essentially a failure of the brain and the cardiovascular system (blood vessels) to adequately communicate and respond to each other. This is not a "heart problem" or "heart defect."

Vasovagal syncope

Acting like pump regulators, autonomic centers in the brain stem help to regulate blood flow during movement. When the regulators forget to function, pressure is no longer maintained and the system temporarily shuts down as blood flow quickly moves away from the brain.

There are a number of forces that work against blood returning to the central part of the body (vital organs and brain): gravity, amount of fluid in the vessels, dilation of the vessels, neurotransmitters (chemicals in the brain that allow nerves to communicate) available to convey messages from the brain and even barometric pressure.

Causes and risk factors:

    After prolonged periods of quiet upright posture (such as standing in line).

  • After being in a warm environment (such as in hot summer weather, a hot crowded room, a hot shower or bath).

  • Intensive exercise.

  • Intense laughter.

  • High altitude.

  • Pressing upon certain places on the throat, sinuses, and eyes.

  • After emotionally stressful events (having blood drawn, being scared or anxious).

  • Some individuals get symptoms soon after eating, when blood flow has shifted to the intestinal circulation during the process of digestion.

  • Alcohol use or drug use, or both.

  • Organic heart disease.


Symptoms may include:


  • Vague lightheadedness.

  • Seizure, aura.

  • Nausea, vomiting, pallor.

  • Recurrent dizziness.

  • Near fainting.

  • Palpitations.

  • Unexplained sweating.

  • Joint or muscle aches.


Diagnosis of vasovagal syncope lies into a clear description by the patient of typical triggers, symptoms, and how much time syncope lasted.

In general, physicians use the tilt table test to determine if a diagnosis is necessary. The patient is placed in a quiet room, on either a hydraulic lift of swinging bed that can rotate between 60º and 90º, moving the patient from supine to head-up position. Heart rate and blood pressure are monitored throughout the test. Although some variation in technique exists within practicing physicians, the patient is usually monitored in the supine position for five minutes, and baseline heart rate and blood pressure measurements are taken. Next, the patient is moved into the head-up tilt position, and changes in blood pressure and heart rate, and the appearance of symptoms are noted every three to five minutes. If the patient experiences syncope, the patient is returned to the supine position, and they are considered diagnosable.

Other tests may include:

    An echocardiogram.

  • A Holter monitor or event monitor.

  • Implantation of an insertable loop recorder.

  • An electrophysiology study.


Vasovagal syncope is most often treated with a combination of increased salt and water intake in conjunction with drugs that regulate blood pressure. It is important for patients to recognize potential triggers and heed warning signs. Treatment can broadly be divided into two categories:

    General measures.

  • Pharmacological options.

General treatment options may include: The patients with vasovagal syncope tend to choose lifestyle changes, and in most cases, this is all that is necessary for controlling the condition. Both recognizing their personal triggers, and learning to recognize when an episode is about to occur are necessary; an increase in the amounts of water and salt intake can prevent attacks. Blood is primarily composed of water and salt, so by increasing the amount of each, blood pressure may rise, possibly preventing syncope. More of both are needed especially in hot weather, or when vigorous exercise is performed.

Pharmacological options may include: Medicinal treatments include beta-blockers, fludrocortisone, midodrine, and SSRIs (selective serotonin reuptake inhibitors). Beta-blockers block the adrenaline system, preventing the abnormal reflex of the sympathetic nervous system that precedes the decrease of blood pressure. Fludrocortisone sends a message to the kidneys to retain more salt and water, thus increasing blood pressure. Midodrine tightens blood vessels. SSRIs are usually used in the treatment of depression or anxiety, but they also block the communication in the brain that triggers the blood vessels to open further.

Patients who seek treatment outside of modern medicine often turn to licorice root, also known as sweet root. One of the active ingredients is glycyrrhizic acid. It has been used worldwide for thousands of years to treat a variety of ailments. Recent studies have shown that is useful in the treatment of heart disease. When consumed in large quantities, licorice root can raise the level of aldosterone (a corticosteroid hormone that is secreted by the cortex of the adrenal gland; regulates sodium and potassium and water balance) found in the blood.


    Regular exercise is important to help reduce excess blood in the lower legs and feet, and improve the flow of blood back to the heart.

  • Get moderate regular aerobic exercise at least 3 days a week for 30 minutes.

  • Do regular exercises to strengthen lower leg muscles.

  • Your doctor may recommend foot exercises. Do exercises as directed.

  • Your doctor may recommend wearing compression stockings, such as when exercising or when legs swell.

  • Tense legs when standing to help push blood out of the lower body.

Other Preventive Measures:

    Avoid dehydration and severe dieting.

  • Liberal salt intake if not contraindicated.

  • Counter pressure support garments from ankles to waist.

  • Avoid prolonged periods of motionless standing.

  • Once with Prodromal or trigger-assume a recumbent position and cough.

  • Avoid triggers like heat exposure, painful stimuli.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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