Vasovagal syncope

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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

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All Medline abstracts: PubMed | HubMed