Vasovagal syncope: Difference between revisions

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*[[Vasovagal fainting in children and teenagers]]
==Different types of vasovagal syncope==
*[[Malignant vasovagal syncope due to blood phobia]]
* [[Young patients]]
*[[Reflex syncope in older adults]]
* [[Old patients]]
*[[Syncope and the eye]]
* [[Post-exercise Syncope]]
*[[Transient loss of consciousness with muscle jerks during a flight: syncope or epilepsy]]  
* [[Blood phobia]]
*[[Post exercise vasovagal syncope]]
* [[Blood donation]]
*[[A pilot with vasovagal syncope: fit to fly]]
* [[Vasovagal syncope during sleep]]  
*[[Hallucinations cured by pacing]]
 
*[[Status vasovagalis]]
==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>

Latest revision as of 14:18, 14 December 2015

Different types of vasovagal syncope

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.


Psychological stressors

Psychological stressors include:

  • Stirring emotional news or witnessing a distressing accident [1],[2]
  • Unexpected pain or threat [1],[3]
  • Unpleasant smells may trigger vasovagal syncope [4],[5]
  • During blood drawing,
  • Vaccination [6]
  • Instrumentation, pain of the procedure may contribute to vasovagal syncope
  • Sharp pain is reported to be an important factor during arterial blood sampling [7].
  • Blood phobia: However, in a patient with blood phobia just thinking or talking about blood drawing may elicit a common faint [8]



Vasovagal syncope in airliners

Vasovagal episodes are the most common in-flight medical events, and may affect patients of all ages [9]. The following may all predispose vasovagal faints during air travel [10]:

  • 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 [11].

Treatment

Patients, who otherwise never experienced a (severe) vasovagal episode may suffer from convulsive syncope during air travel [12]. 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 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

  1. Lewis T. A Lecture on VASOVAGAL SYNCOPE AND THE CAROTID SINUS MECHANISM. Br Med J. 1932 May 14;1(3723):873-6. DOI:10.1136/bmj.1.3723.873 | PubMed ID:20776843 | HubMed [Lewis]
  2. Engel GL, Romano J, & McLin TR (1944). Vasodepressor and carotid sinus syncope - clinical, eletroencephalographic and electrocardiographic observations. Arch Intern Med 74, 100-119.

    [Engel44]
  3. GREENFIELD AD (1951). An emotional faint. Lancet 1, 1302-1303.

    [Greenfield]
  4. Engel GL & Romano J (1947). Studies of Syncope: IV. Biologic interpretation of vasodepressor syncope. Psychosom Med 9, 288-294.

    [Engel47]
  5. Ganzeboom KS, Colman N, Reitsma JB, Shen WK, and Wieling W. Prevalence and triggers of syncope in medical students. Am J Cardiol. 2003 Apr 15;91(8):1006-8, A8. DOI:10.1016/s0002-9149(03)00127-9 | PubMed ID:12686351 | HubMed [Ganzeboom]
  6. Braun MM, Patriarca PA, and Ellenberg SS. Syncope after immunization. Arch Pediatr Adolesc Med. 1997 Mar;151(3):255-9. DOI:10.1001/archpedi.1997.02170400041007 | PubMed ID:9080932 | HubMed [Braun]
  7. Rushmer, R.F. Circulatory collapse following mechanical stimulation of arteries. Am. J. Physiol. 1944;141:722.

    [Rushmer]
  8. Van Dijk N, Velzeboer SC, Destrée-Vonk A, Linzer M, and Wieling W. Psychological treatment of malignant vasovagal syncope due to bloodphobia. Pacing Clin Electrophysiol. 2001 Jan;24(1):122-4. DOI:10.1046/j.1460-9592.2001.00122.x | PubMed ID:11227958 | HubMed [Dijk01]
  9. Gendreau MA and DeJohn C. Responding to medical events during commercial airline flights. N Engl J Med. 2002 Apr 4;346(14):1067-73. DOI:10.1056/NEJMra012774 | PubMed ID:11932475 | HubMed [Gendreau]
  10. Sutton R. Vasovagal syncope: prevalence and presentation. An algorithm of management in the aviation environment. Eur Heart J Suppl. 1999 Apr;1 Suppl D:D109-13. PubMed ID:11543489 | HubMed [Sutton]
  11. Halliwill JR and Minson CT. Cardiovagal regulation during combined hypoxic and orthostatic stress: fainters vs. nonfainters. J Appl Physiol (1985). 2005 Mar;98(3):1050-6. DOI:10.1152/japplphysiol.00871.2004 | PubMed ID:15531565 | HubMed [Halliwill]
  12. Wieling W, Krediet CT, and Wilde AA. Flush after syncope: not always an arrhythmia. J Cardiovasc Electrophysiol. 2006 Jul;17(7):804-5. DOI:10.1111/j.1540-8167.2006.00520.x | PubMed ID:16836688 | HubMed [Wieling06]
  13. Krediet CT, Wilde AA, Wieling W, and Halliwill JR. Exercise related syncope, when it's not the heart. Clin Auton Res. 2004 Oct;14 Suppl 1:25-36. DOI:10.1007/s10286-004-1005-1 | PubMed ID:15480927 | HubMed [Krediet04b]
  14. Bjurstedt H, Rosenhamer G, Balldin U, and Katkov V. Orthostatic reactions during recovery from exhaustive exercise of short duration. Acta Physiol Scand. 1983 Sep;119(1):25-31. DOI:10.1111/j.1748-1716.1983.tb07301.x | PubMed ID:6650203 | HubMed [Bjurstedt]
  15. Finlay JB, Hartman AF, and Weir RC. Post-swim orthostatic intolerance in a marathon swimmer. Med Sci Sports Exerc. 1995 Sep;27(9):1231-7. PubMed ID:8531620 | HubMed [Finlay]
  16. Grady GF, Rodman M, and Larsen LH. Hepatitis B antibody in conventional gamma-globulin. J Infect Dis. 1975 Oct;132(4):474-7. DOI:10.1093/infdis/132.4.474 | PubMed ID:52682 | HubMed [Tsutsumi]
  17. Holtzhausen LM and Noakes TD. The prevalence and significance of post-exercise (postural) hypotension in ultramarathon runners. Med Sci Sports Exerc. 1995 Dec;27(12):1595-601. PubMed ID:8614313 | HubMed [Holtzhausen95]
  18. Holtzhausen LM and Noakes TD. Collapsed ultraendurance athlete: proposed mechanisms and an approach to management. Clin J Sport Med. 1997 Oct;7(4):292-301. PubMed ID:9397327 | HubMed [Holtzhausen97]
  19. Schlesinger Z. Letter: Life-threatening "vagal reaction" to physical fitness test. JAMA. 1973 Nov 26;226(9):1119. PubMed ID:4800477 | HubMed [Schlesinger]
  20. Jardine DL, Krediet CT, Cortelli P, & Wieling W (2006b). Sleep syncope: clinical features and autonomic profiles. Clin Auton Res 16, 321-322.

    [Jardine06b]
  21. Krediet CT, Jardine DL, Cortelli P, Visman AG, and Wieling W. Vasovagal syncope interrupting sleep?. Heart. 2004 May;90(5):e25. DOI:10.1136/hrt.2003.031294 | PubMed ID:15084573 | HubMed [Krediet04a]
  22. Tinuper P, Bisulli F, Cerullo A, Carcangiu R, Marini C, Pierangeli G, and Cortelli P. Ictal bradycardia in partial epileptic seizures: Autonomic investigation in three cases and literature review. Brain. 2001 Dec;124(Pt 12):2361-71. DOI:10.1093/brain/124.12.2361 | PubMed ID:11701591 | HubMed [Tinuper]
  23. Covanis A. Panayiotopoulos syndrome: a benign childhood autonomic epilepsy frequently imitating encephalitis, syncope, migraine, sleep disorder, or gastroenteritis. Pediatrics. 2006 Oct;118(4):e1237-43. DOI:10.1542/peds.2006-0623 | PubMed ID:16950946 | HubMed [Covanis]
  24. Brierley EJ, Jackson MJ, Clark RS, and Kenny RA. Alarming asystole. Lancet. 2001 Jun 30;357(9274):2100. DOI:10.1016/s0140-6736(00)05184-9 | PubMed ID:11445105 | HubMed [Brierley]
  25. Pathy MS. Defaecation syncope. Age Ageing. 1978 Nov;7(4):233-6. DOI:10.1093/ageing/7.4.233 | PubMed ID:83099 | HubMed [Pathy]
  26. Fisher CM. Syncope of obscure nature. Can J Neurol Sci. 1979 Feb;6(1):7-20. DOI:10.1017/s0317167100119316 | PubMed ID:264159 | HubMed [Fisher]

All Medline abstracts: PubMed | HubMed