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==Psychological stressors== | ==Psychological stressors== | ||
Psychological stressors include stirring emotional news or witnessing a distressing accident | 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> or 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>. However, in a patient with blood phobia just thinking or talking about blood drawing may elicit a common faint <cite>Dijk01</cite>. | ||
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==Post-exercise vasovagal syncope== | ==Post-exercise vasovagal syncope== | ||
Syncope after exercise is often neurally mediated, i.e. post-exercise vasovagal syncope. This condition is typically diagnosed in young fit, furthermore healthy young patients. Foremost, the diagnostic workup of all patients presenting with exercise-related syncope is aimed at excluding dangerous cardiac conditions and includes echocardiography and exercise testing | Syncope after exercise is often neurally mediated, i.e. post-exercise vasovagal syncope. This condition is typically diagnosed in young fit, furthermore healthy young patients. Foremost, the diagnostic workup of all patients presenting with exercise-related syncope is aimed at excluding dangerous cardiac conditions and includes echocardiography and exercise testing <cite>Krediet04b</cite>. | ||
Characteristically, syncope may occur while the individual is standing motionless during the first five to ten minutes after exercise (Bjurstedt et al., 1983). Especially athletes in the (ultra) endurance sports are at risk for post exercise vasovagal syncope e.g. after marathon swimming (Finlay et al., 1995) or marathon running (Tsutsumi & Hara, 1979;Holtzhausen & Noakes, 1995;Holtzhausen & Noakes, 1997). | Characteristically, syncope may occur while the individual is standing motionless during the first five to ten minutes after exercise (Bjurstedt et al., 1983). Especially athletes in the (ultra) endurance sports are at risk for post exercise vasovagal syncope e.g. after marathon swimming (Finlay et al., 1995) or marathon running (Tsutsumi & Hara, 1979;Holtzhausen & Noakes, 1995;Holtzhausen & Noakes, 1997). | ||
Vasovagal syncope after routine treadmill testing is rare (estimated 0,2% (Schlesinger, 1973)). However, when treadmill testing is immediately followed by passive head-up tilt testing, this percentage can increase up to 50-70% (Bjurstedt et al., 1983). Vasovagal syncope after exercise is considered to be a benign occurrence (Krediet et al., 2004b). | Vasovagal syncope after routine treadmill testing is rare (estimated 0,2% (Schlesinger, 1973)). However, when treadmill testing is immediately followed by passive head-up tilt testing, this percentage can increase up to 50-70% (Bjurstedt et al., 1983). Vasovagal syncope after exercise is considered to be a benign occurrence (Krediet et al., 2004b). | ||
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Some patients with a diagnosis of defaecation syncope (see below) described abdominal and pre-syncopal symptoms that started simultaneously during sleep (Pathy, 1978;Fisher, 1979); there may be some overlap between this condition and sleep syncope (Jardine et al., 2006a). | Some patients with a diagnosis of defaecation syncope (see below) described abdominal and pre-syncopal symptoms that started simultaneously during sleep (Pathy, 1978;Fisher, 1979); there may be some overlap between this condition and sleep syncope (Jardine et al., 2006a). | ||
==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 | |||
</biblio> | |||
=Initial Orthostatic Hypotension= | =Initial Orthostatic Hypotension= | ||