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Aborting a vasovagal faint by the combination of leg crossing and muscle tensing: Difference between revisions
Aborting a vasovagal faint by the combination of leg crossing and muscle tensing (view source)
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{{case_present| | {{case_present| | ||
[[File:Effects_of_leg_crossing. | [[File:Effects_of_leg_crossing.jpg | thumb | 500px | left | Figure 1. Effects of leg crossing with muscle tensing on blood pressure, heart rate and cardiac output. For details see text.]] | ||
A 28 years old male patient was evaluated for recurrent episodes of transient loss of consciousness, presumably of vasovagal origin. The episodes typical took place during prolonged standing in a hot environment. Prior to the loss of consciousness he felt light-headed and perspirated heavily.Tilt table testing reproduced these symptoms. Figure 1 shows blood pressure, heart rate and cardiac output during this vasovagal response, measured using Finometer/ Modelflow (FMS, The Netherlands). Note the progressive fall in finger arterial pressure. At the black bar the patient crossed his legs and tensed leg and abdominal muscles as physical counter manoeuvre to combat the vasovagal reaction (Fig. 1). After crossing the legs and tensing of leg and abdominal muscles blood pressure recovered quickly. This rise in blood pressure was associated with a steep increase in cardiac output. Intact baroreflex function causes a short decrease in heart rate when blood pressure overshoots the physiological set point at the start of the manoeuvre. | A 28 years old male patient was evaluated for recurrent episodes of transient loss of consciousness, presumably of vasovagal origin. The episodes typical took place during prolonged standing in a hot environment. Prior to the loss of consciousness he felt light-headed and perspirated heavily.Tilt table testing reproduced these symptoms. Figure 1 shows blood pressure, heart rate and cardiac output during this vasovagal response, measured using Finometer/ Modelflow (FMS, The Netherlands). Note the progressive fall in finger arterial pressure. At the black bar the patient crossed his legs and tensed leg and abdominal muscles as physical counter manoeuvre to combat the vasovagal reaction (Fig. 1). After crossing the legs and tensing of leg and abdominal muscles blood pressure recovered quickly. This rise in blood pressure was associated with a steep increase in cardiac output. Intact baroreflex function causes a short decrease in heart rate when blood pressure overshoots the physiological set point at the start of the manoeuvre. | ||
At the striped bar leg crossing is replaced by single hand gripping as a physical counter manoeuvre. Although there is an effect, it is far less pronounced than during leg crossing and the patient has to be tilted back because of ongoing complaints at a systolic blood pressure of about 75 mm Hg (arrow). | At the striped bar leg crossing is replaced by single hand gripping as a physical counter manoeuvre. Although there is an effect, it is far less pronounced than during leg crossing and the patient has to be tilted back because of ongoing complaints at a systolic blood pressure of about 75 mm Hg (arrow). | ||
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== Editor's comments == | == Editor's comments == | ||
[[File:Effects of squatting. | [[File:Effects of squatting.jpg | thumb | 500px | left | Figure 2. Effects of squatting (upper panel), sitting with head between knees (middle panel) and lying down (lower panel) on blood pressure during impending vasovagal syncope (from 10 with permission).]] | ||
Inspired by observations that leg crossing and leg muscle tensing increase orthostatic tolerance in patients with autonomic failure (see [[Physical manoeuvres that reduce postural hypotension in autonomic failure]]) <cite>1</cite>, we documented the effectiveness of leg crossing and muscle tensing to postpone or abort vasovagal syncope <cite>2</cite>. Brignole reported a similar effect of arm counterpressure manoeuvres <cite>3</cite>. He based his intervention on the anecdotal advise from some general practitioners in Italy, to apply muscle tensing by gripping a wooden egg (used for darning socks) at the start of an impending faint. | Inspired by observations that leg crossing and leg muscle tensing increase orthostatic tolerance in patients with autonomic failure (see [[Physical manoeuvres that reduce postural hypotension in autonomic failure]]) <cite>1</cite>, we documented the effectiveness of leg crossing and muscle tensing to postpone or abort vasovagal syncope <cite>2</cite>. Brignole reported a similar effect of arm counterpressure manoeuvres <cite>3</cite>. He based his intervention on the anecdotal advise from some general practitioners in Italy, to apply muscle tensing by gripping a wooden egg (used for darning socks) at the start of an impending faint. | ||
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#10 pmid=12842648 | #10 pmid=12842648 | ||
</biblio> | </biblio> | ||
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