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Vasovagal syncope: Difference between revisions
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*Vasovagal | ==Different types of vasovagal syncope== | ||
* | * [[Young patients]] | ||
* | * [[Old patients]] | ||
* | * [[Post-exercise Syncope]] | ||
* | * [[Blood phobia]] | ||
* [[Blood donation]] | |||
* [[Vasovagal syncope during sleep]] | |||
==Triggers for Vasovagal Syncope== | |||
Vasovagal syncope can occur after exposure of a lot of different triggers. Recognised triggers for vasovagal syncope are prolonged orthostatic stress, blood drawing, medical instrumentation and psychological stressors. | |||
<br> | |||
==Psychological stressors== | |||
Psychological stressors include: | |||
*Stirring emotional news or witnessing a distressing accident <cite>Lewis</cite>,<cite>Engel44</cite> | |||
*Unexpected pain or threat <cite>Lewis</cite>,<cite>Greenfield</cite> | |||
*Unpleasant smells may trigger vasovagal syncope <cite>Engel47</cite>,<cite>Ganzeboom</cite> | |||
*During blood drawing, | |||
*Vaccination <cite>Braun</cite> | |||
*Instrumentation, pain of the procedure may contribute to vasovagal syncope | |||
*Sharp pain is reported to be an important factor during arterial blood sampling <cite>Rushmer</cite>. | |||
*Blood phobia: ''However, in a patient with blood phobia just thinking or talking about blood drawing may elicit a common faint <cite>Dijk01</cite>'' | |||
<br> | |||
==Vasovagal syncope in airliners== | |||
Vasovagal episodes are the most common in-flight medical events, and may affect patients of all ages <cite>Gendreau</cite>. | |||
The following may all predispose vasovagal faints during air travel <cite>Sutton</cite>:<br> | |||
* Prolonged motionless sitting | |||
* The use of alcohol | |||
* Anxiety | |||
* Mild hypoxia during air travel | |||
Cabin pressure in commercial aircraft is usually adjusted to the equivalent of an altitude of 1500 to 2500 m above sea level. It appears that hypoxic syncope results from the super-imposed vasodilator effects of hypoxia on the cardiovascular system <cite>Halliwill</cite>. | |||
===Treatment=== | |||
Patients, who otherwise never experienced a (severe) vasovagal episode may suffer from convulsive syncope during air travel <cite>Wieling06</cite>. These patients should be advised to have: | |||
* A high salt intake in the days prior to travelling by plane | |||
* Reduce anti-hypertensive medication –if feasible- | |||
* And drink non-alcoholic beverages galore during the trip. | |||
Especially during long flights (> 2 hours) they should perform in-chair [[Physical counterpressure manoeuvers|muscle tensing and relaxing exercise]] and have a regular walk through the isle. In recurrent cases '''midodrine''' prior to flying or '''supportive stockings''' can be considered. | |||
==References== | |||
<biblio> | |||
#Lewis pmid=20776843 | |||
#Engel44 Engel GL, Romano J, & McLin TR (1944). Vasodepressor and carotid sinus syncope - clinical, eletroencephalographic and electrocardiographic observations. Arch Intern Med 74, 100-119. | |||
#Greenfield GREENFIELD AD (1951). An emotional faint. Lancet 1, 1302-1303. | |||
#Engel47 Engel GL & Romano J (1947). Studies of Syncope: IV. Biologic interpretation of vasodepressor syncope. Psychosom Med 9, 288-294. | |||
#Ganzeboom pmid=12686351 | |||
#Braun pmid=9080932 | |||
#Rushmer Rushmer, R.F. Circulatory collapse following mechanical stimulation of arteries. Am. J. Physiol. 1944;141:722. | |||
#Dijk01 pmid=11227958 | |||
#Krediet04b pmid=15480927 | |||
#Bjurstedt pmid=6650203 | |||
#Finlay pmid=8531620 | |||
#Tsutsumi pmid=52682 | |||
#Holtzhausen95 pmid=8614313 | |||
#Holtzhausen97 pmid=9397327 | |||
#Schlesinger pmid=4800477 | |||
#Gendreau pmid=11932475 | |||
#Sutton pmid=11543489 | |||
#Halliwill pmid=15531565 | |||
#Wieling06 pmid=16836688 | |||
#Jardine06b Jardine DL, Krediet CT, Cortelli P, & Wieling W (2006b). Sleep syncope: clinical features and autonomic profiles. Clin Auton Res 16, 321-322. | |||
#Krediet04a pmid=15084573 | |||
#Tinuper pmid=11701591 | |||
#Covanis pmid=16950946 | |||
#Brierley pmid=11445105 | |||
#Pathy pmid=83099 | |||
#Fisher pmid=264159 | |||
</biblio> | |||