Materiały źródłowe

• #1 Vasovagal Episode – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470277/

  Vasovagal syncope is the most common form of syncope in adults. More than 85% of syncopal events in people younger than 40 years are attributable to vasovagal syncope. Even in geriatric patients, more than 50% of syncopal episodes are due to vasovagal syncope. Vasovagal syncope requires an intact and functioning autonomic nervous system, and therefore, its incidence is low in populations with autonomic nervous system dysfunction, such as patients with Parkinson disease. The lifetime incidence of an episode of vasovagal syncope is more than 33%. […] The etiology of vasovagal syncope is unclear. Some believe that the vasovagal reaction is an exaggeration of an adaptive response meant to assist in hemostasis in times of trauma. In other words, in the setting of physical trauma, the body reflexively lowers blood pressure and heart rate to reduce the amount of bleeding. Others have sought a genetic link for the syndrome. Research elucidating a genetic predisposition for vasovagal syncope is challenging due to the high background incidence of the disease, but genomic analysis demonstrates some differences in copy number variations in families with a high burden of reflex syncope. More research in this area is warranted.

• #2 Syncope: epidemiology, etiology, and prognosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4258989/

  Syncope is a common medical problem, with a frequency between 15% and 39%. […] In the general population, the annual number episodes are 18.139.7 per 1000 patients, with similar incidence between genders. […] However, there is a significant increase in the incidence of syncope after 70 years of age with rate annual 19.5 per thousand individuals after 80 years. […] Among the causes of syncope, the mediated neural reflex, known as neurocardiogenic or vasovagal syncope, is the most frequent. […] In the general population, the annual number episodes are 18.139.7 per 1000 patients, with similar incidence between genders, and with high prevalence between 10 and 30 years of age, mainly of vasovagal syncope (Moya et al., 2009). […] The first report of the incidence of syncope is 6.2 per 1000 person-years.

• #3 Textbook | Vasovagal Syncope | Syncopedia

  https://syncopedia.org/vasovagal-syncope/

  Vasovagal syncope is the most common cause of syncope making up 60% of the cases. The prevalence in the general population is ~40%. Most people dont attend a physician after a common vasovagal faint. The age at which people experience their first faint shows two peaks: one in adolescents and one peak in people 60 years-old. […] The prevalence is high. In several questionnaire studies in medical students a prevalence of up to 40% was found.

• #4 Epidemiology of Vasovagal Syncope | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-09102-0_4

  Vasovagal syncope is a common symptom, but its true incidence is difficult to estimate because only a small percentage of patients with syncope seek medical advice. The estimated prevalence varies according to the setting and the population studied, but it is likely that up to 40 % of people faint at least once in their life and prevalence is higher in females. […] Syncope incidence shows a bimodal distribution, with two peaks: before 20 and after 65 years old. While vasovagal syncope is the more likely cause of syncope in young people, cardiovascular diseases, orthostatic hypotension and multiple causes (reflecting a higher frailty) are more prevalent in the elderly.

• #5 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  Data regarding epidemiology and demographics of syncope vary with the populations under investigation as well as with how syncope is defined and/or characterized. Estimated prevalence has been reported to be as high at 41%, with a 13.5% prevalence of recurrent syncope. In adults, vasovagal syncope is the most common form of syncope. […] An estimated 1 million plus US emergency department visits are from syncope or presyncope. Framingham data demonstrated a first occurrence rate of 6.2 cases per 1000 patient-years. Syncope reoccurs in 3% of affected individuals, and approximately 10% of affected individuals have a cardiac etiology. […] Data from Europe and Japan suggest an occurrence rates similar to that in the United States, accounting for 1-3.5% of ED visits. In a 2024 report of findings from a multicenter European prospective study of 952 adults aged at least 18 years who presented to EDs with undifferentiated or suspected syncopal-related transient loss of consciousness (TLOC), Reed et al found a 1% prevalence of syncope in the ED, with about 4 in 10 patients admitted. This Syncope Evaluation in the Emergency Department (SEED) study noted admission rates rose with the presence of increasing high-risk factors (on the basis of the European Society of Cardiology criteria. See the Guidelines section.), which 75% of patients exhibited.

• #6 Syncope: epidemiology, etiology, and prognosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4258989/

  However, there is a significant increase in the incidence of syncope after 70 years of age, with 5.7 episodes/1000 individuals per year between 60 and 69 years old and with 11.1 episodes/1000 individuals per year between 70 and 79 years age. After 80 years, the annual incidence may reach 19.5 per 1000 individuals (Soteriades et al., 2002; Colman et al., 2004). […] This framework is responsible for 35% of emergency department visits, with a hospitalization rate in about 40% of cases, with an average stay of 5.5 days. […] The main causes of syncope are summarized in Table 1 and will be discussed below. […] The mechanism of vasovagal syncope is explained by the BezoldJarisch reflex, which is triggered due to decreased venous return resulting in inadequate ventricular filling and vigorous cardiac contraction.

• #7 Complexity of syncope in elderly people: a comprehensive geriatric approach | HKMJ

  https://www.hkmj.org/abstracts/v24n2/182.htm

  Syncope is prevalent in elderly populations. After a peak in younger populations (age, 10-30 years), the incidence of syncope increases sharply from 5.4 events per 1000 person-years in people aged 60 to 69 years to 11.1 events per 1000 person-years in those aged 70 to 79 years, and reaching 19.5 events per 1000 person-years in those aged 80 years or older. […] The prevalence of syncope is high for the institutionalised elderly, at 23%. […] Reflex syncope is a heterogeneous group of conditions, including vasovagal syncope, situational syncope, and carotid sinus syndrome, and is the most frequent cause of syncope in the elderly people (44% of cases). […] Vasovagal syncope is the most common form of reflex syncope and is mediated by the vasovagal reflex. […] The classic prodromal features (pallor, diaphoresis, nausea, and warmth) are less prominent in elderly people.

• #8 Syncope: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/811669-overview

  No significant differences regarding race are observed with respect to syncope risk. Although large prospective studies fail to show clinically significant differences between men and women, data from Olmsted County, Minnesota, found a higher prevalence reported among females. National Hospital Ambulatory Medical Care Survey (NHAMCS) data show that syncope occurs in all age groups but is most common in older adult populations. Noncardiac causes tend to be more common in young adults, whereas cardiac syncope is more common with male sex and becomes increasingly more frequent with advancing age. […] Advancing age is an independent risk factor for both syncope and death. Various studies suggest categorizing patients older than 45 years, 65 years, and 80 years as being at higher risk. Advancing age correlates with increasing frequency of coronary artery and myocardial disease, arrhythmia, vasomotor instability, autonomic failure, polyneuropathy, and use of polypharmacy. Predictors of recurrent syncope in this population include aortic stenosis, atrioventricular or left bundle branch block, atrial fibrillation, heart failure, impaired kidney function, and chronic obstructive pulmonary disorder.

• #9 Evaluation of Syncope | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p640.html

  Syncope is classified as neurally mediated (i.e., carotid sinus hypersensitivity, situational, or vasovagal), cardiac, orthostatic, or neurogenic. Older adults are more likely to have orthostatic, carotid sinus hypersensitivity, or cardiac syncope, whereas younger adults are more likely to have vasovagal syncope. […] The cumulative incidence of syncope is 3 to 6 percent over 10 years, and 80 percent of patients have their first episode before 30 years of age. The overall distribution of syncope is equal between men and women; however, women are more likely to have an event at the extremes of age. Compared with persons 50 to 59 years of age, the incidence increases two- and threefold, respectively, in persons 70 to 79 years of age and in persons 80 years or older. Population-based studies indicate that approximately 40 percent of adults have experienced syncope, with women being more likely to report a syncopal event.

• #10 Evaluation of Syncope | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p640.html

  A retrospective study of more than 70,000 patients in the Netherlands compared the evaluation of syncope in the primary care setting versus the emergency department. The event rate for syncope in general practice exceeded the rate in the emergency department by a factor of 13 (9.3 versus 0.7 per 1,000 patient-years). Patients presenting to the emergency department with syncope were older and had a higher prevalence of cardiovascular disorders. […] Approximately 20 to 50 percent of patients have unexplained syncope after intensive diagnostic evaluation. […] Neurally mediated syncope is the most common and is seen primarily in young adults. A reflex response causes vasodilation, bradycardia, and systemic hypotension leading to decreased cerebral blood flow. Neurally mediated syncope includes vasovagal syncope, situational syncope, and carotid sinus syndrome/hypersensitivity.

• #11

  http://savvysciencepublisher.com/jms/index.php/jne/article/view/811

  Vasovagal syncope is the most common cause of syncope in pediatric patients. […] The present study is aim to provide a comprehensive literature review of the latest advances in the diagnosis and treatment of vasovagal syncope in children. […] Diagnosis of vasovagal syncope is based on clinical history. […] For patients with suspected VVS but lack of confident diagnosis after initial assessment, head-up tilt test is helpful. […] There are four options for treatment of vasovagal syncope: conservative therapy, pharmacologic therapy, pacemaker therapy, and catheter ablation of ganglionated plexi. […] Conservative therapy (health education, avoidance of triggers, salts and water intake, physical countermeasures and orthostatic training) is recommended for patients with occasional syncope.

• #12 Syncope – BroadcastMed

  https://www.broadcastmed.com/cardiology/6977/videos/syncope

  1% to 3% of annual ER visits are related to syncope. 6% of possible admissions are for syncope, with a median length of stay up to 5 and 1/2 days. And up to 50% of our patient population may experience syncope. […] About 15% of children before the age of 18 will have their first episode of syncope. In the male population, between 40 and 59 years old, it’s another 16%, women 40 to 49, 19%. As people age, there’s another bump in how many species are experiencing syncope. So in the over 70 population, it will be up to 23% within a 10-year period, over the age of 70. […] The problem with syncope is that syncope is a symptom. It’s not really a diagnosis. And there’s a lot of different conditions that can cause syncope. […] The American College of Cardiology recommends that you do a history, an exam, and an ECG. If, based on this, you have a diagnosis of orthostatic hypotension or vasovagal syncope, you’re done.

• #13 Postural syncope: mechanisms and management | The Medical Journal of Australia

  https://www.mja.com.au/journal/2007/187/5/postural-syncope-mechanisms-and-management

  Epidemiology of syncope […] Postural syncope has a bimodal distribution in the general population. The first peak, at around 15 years, predominates in girls, with the vast majority of cases being due to vasovagal syncope. In the second peak, at over 60 years, vasovagal syncope, orthostatic hypotension and situational syncope (eg, during micturition or after meals) are predominant, but clinical presentations are often diverse, posing a diagnostic challenge. Cardiac syncope remains a major culprit in this age group and must be excluded. […] […] […] Vasovagal syncope is a common and clinically challenging disorder widely recognised in the lay community as a faint or blackout. It is characterised physiologically by sudden hypotension and varying degrees of bradycardia. The mechanism remains a matter of controversy. Excess venous pooling and abnormal vasodilation while standing, thus reducing venous return to the heart, is the most commonly accepted explanation. Vasovagal syncope is classically provoked by prolonged standing or sitting. However, other stimuli may be operative in situational syncope (eg, in response to venepuncture, pain or emotion). Most patients can be diagnosed by careful history taking, examination and electrocardiography. Symptoms consistent with vasovagal syncope and most predictive of the diagnosis include visual blurring, sweating, nausea, warmth, light-headedness and fatigue. Palpitations are also a common feature of the prodrome. A third of patients have no warning symptoms. Young patients tend to present with typical features, while older patients more commonly have an atypical presentation. A brief convulsion is quite common, and mild seizure activity due to cerebral hypoperfusion may occur in up to two-thirds of patients. It has been estimated that about 20% of patients undergoing long-term follow-up in hospital epilepsy clinics are misdiagnosed their transient loss of consciousness being due to syncope rather than epileptic seizure. Tilt-table testing may be needed to confirm a suspected diagnosis of vasovagal syncope. The key is in correlating symptoms on the tilt table with those in the real world.

• #14 Malignant vasovagal syncope due to blood phobia | Syncopedia

  https://syncopedia.org/malignant-vasovagal-syncope-due-to-blood-phobia/

  Vasovagal syncope is a frightening but usually benign condition. A vasovagal collapse can occur after certain triggers (emotional or prolonged standing) which cause a reduction in sympathetic outflow to the systemic circulation and augmentation of efferent vagal activity. […] The asystole clearly was instrumental in causing syncope in this patient. The pronounced sinus arrhythmia during Holter monitoring and forced breathing indicate this patients susceptibility to vagal stimulation. Vasovagal syncope with prolonged asystole is uncommon. […] Intense fear of seeing blood is seen in 2-4.5% of children and adults. Blood-injury phobia usually starts in childhood, is often familial and is a distinctive focal phobia. […] We conclude that vasovagal syncope due to bloodphobia, even with very long periods of asystole, can be treated using psychological techniques instead of pacemaker implantation.

• #15 Pulsenotes | Vasovagal syncope

  https://app.pulsenotes.com/medicine/neurology/notes/vasovagal-syncope

  Vasovagal syncope is extremely common. Vasovagal syncope accounts for more than one-third of cases of syncope. It is the most cause of syncope in young patients. It is common in older adults, but usually, a deeper search to exclude other causes of syncope is required. […] The diagnosis of vasovagal syncope requires a thorough history and clinical examination. The history of prodromal symptoms following a typical trigger in a patient with no significant medical history is usually classic for vasovagal syncope.

• #16 Complexity of syncope in elderly people: a comprehensive geriatric approach | HKMJ

  https://www.hkmj.org/abstracts/v24n2/182.htm

  Carotid sinus syndrome is regarded as a significant cause of syncope and unexplained falls in the elderly people; as many as 45% of elderly patients presenting with syncope or unexplained falls demonstrate carotid sinus hypersensitivity. […] Orthostatic hypotension (OH) is prevalent in elderly people and in those who are frail, affecting up to 18% of people aged 65 years or older and up to 52% of institutionalised elderly patients. […] It also accounts for 30% of cases of syncope in patients aged 75 years or older. […] Cardiac syncope accounts for up to 15% of cases of syncope in the elderly people. […] The prevalence of unexplained syncope has decreased as the use of diagnostic techniques, such as the tilt-table test and CSM, has increased. […] Multiple causes of syncope are commonly observed in elderly patients: in 23.5% of those aged 65 or older and in 13.4% of those younger than 65 years.

• #17 Complexity of syncope in elderly people: a comprehensive geriatric approach | HKMJ

  https://www.hkmj.org/abstracts/v24n2/182.htm

  The presence of multiple causes also correlates with poor survival. […] Overall prognosis is worse in patients with an underlying cardiac disease such as myocardial infarction, arrhythmia, structural cardiac defect, cardiomyopathy, or congestive heart failure, regardless of the occurrence or aetiology of syncope. […] The presence of multiple potential causes of syncope also predicts a lower survival rate as compared with a single cause of syncope (73% vs 89% at 4 years). […] Syncope can negatively affect quality of life, particularly in patients who are older, have multiple co-morbidities, and experience recurrent episodes of syncope. […] The relationship between frailty and syncope is not well described in the literature. However, there is an interaction between ageing, co-morbidities, and the development of frailty.

• #18 Do Vaccines Cause Syncope? – Institute for Vaccine Safety

  https://www.vaccinesafety.edu/do-vaccines-cause-syncope/

  Vaccines currently routinely recommended to the general population in the U.S. can rarely cause syncope up to an hour after vaccination, most frequently among adolescents, and especially among females 11-18 years of age. […] A 2013 study by the U.S. Armed Forces estimated annual rates of syncope associated with immunization to be between 4.4 and 14.1 events per 100,000 immunizations. […] The 2012 IOM report described a number of cases of syncope after vaccination. Due to the consistency of the prodromal symptoms, such as dizziness and pallor, and that most cases had a latency of 15 minutes or less between vaccine injection and the development of vasovagal syncope, the IOM concluded that this mechanistic evidence was strong and presented definitive clinical evidence. […] Syncope following vaccination has also occasionally been reported via passive surveillance systems.

• #19 Syncope After Vaccination — United States, January 2005–July 2007

  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a2.htm

  A total of 463 reports of postvaccination syncope during January 1, 2005–July 31, 2007, were identified among persons aged 5 years, compared with 203 reports during 2002–2004. The rate of reports for postvaccination syncope among persons aged 5 years were as follows: 0.30 reports per million doses distributed in 2002, 0.35 per million doses distributed in 2003, 0.28 per million doses distributed in 2004, 0.31 per million doses distributed in 2005, and 0.54 per million doses distributed in 2006. Compared with reports received during 2002–2004, those received during 2005–2007 were more likely to involve females (61.1% versus 77.5%) or persons aged 11–18 years (47.3% versus 62.0%). […] Thirty-three (7.1%) of the 463 postvaccination syncope reports during 2005–2007 were coded as serious; the percentage was not substantially different from the corresponding 20 (9.9%) serious reports during the earlier comparison period. The 26 patients ranged in age from 11 to 84 years (median: 18 years), and 20 (76.9%) were female. Similar to the findings for syncope reports overall, females aged 11–18 years accounted for the largest number of serious syncope reports (n = 11 [42.3%]).

• #20

  https://journals.lww.com/cjsportsmed/fulltext/2024/03000/convulsive_syncope_as_a_complication_of_outpatient.9.aspx

  Sports medicine providers often perform various outpatient procedures to manage musculoskeletal and neuropathic conditions. Vasovagal syncope is a rare but a possible complication. […] Vasovagal syncope is possible with a reported incidence of 0.6% to 2.6% after injection-based procedures. […] Based on literature review, vasovagal reactions occurred between a range of 0.6% to 2.6% after any type of injection with zero reports of convulsive syncope.

• #21 Syncope, Reflex (Vasovagal Syncope) | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117667/all/Syncope_Reflex__Vasovagal_Syncope_?q=Anxiety

  Mortality: cardiac-related syncope 2030% and 5% in idiopathic syncope. […] Age: any age. […] Incidence ranges from 7% in children aged 18 years and 15% in adults aged 70 years. […] 3662% of all syncopal episodes. […] 30% recurrence rate. […] Prevalence 22% in the general population.

• #22 Blackout/Transient Loss of Consciousness (T- LoC) and Syncope Epidemiology | STARS

  http://www.starstloc.org/why_set_up_a_t-loc_clinic/t-_loc_epidemiology

  Syncope is technically defined as a transient, self-limited loss of consciousness, usually leading to collapse. The underlying cause of syncope is a temporary but sudden reduction in blood supply, and hence oxygen, to the brain as a result of cardiovascular conditions. The temporary but sudden reduction in blood supply triggering syncope is caused by vasodilation, hypotension and arrhythmia (bradycardia, tachycardia or valvular disease). Reflex syncope is known as vasovagal syncope in adults and reflex anoxic seizures/reflex asystolic syncope in children. […] Most T-LoC cases presented to primary care or emergency departments are in fact syncope. Syncope is a very common, yet little known condition: up to 50 percent of people experience syncope at least once during their lives. Approximately 35 percent of patients have recurrent syncope episodes within three years and of these 82 percent experience at least one additional episode within two years.

• #23 Vasovagal Syncope: A Review of Current and Future Strategies – touchCARDIOLOGY

  https://touchcardio.com/syncope/journal-articles/vasovagal-syncope-a-review-of-current-and-future-strategies/

  Vasovagal syncope is common, and while it is usually associated with a benign prognosis, it results in significant physical and psychological morbidity for affected individuals. […] With a cumulative lifetime incidence of 35-50%, syncope accounts for 13% of emergency department visits. Vasovagal syncope (VVS) is the most common cause of syncope. […] Recurrent VVS is associated with impaired quality of life, and functional impairment similar to other chronic diseases such as back pain and rheumatoid arthritis. […] Despite advances in the understanding of the pathophysiology of VVS, significant uncertainty remains. Individuals with VVS represent a heterogenous patient population, and different mechanisms are likely to contribute. […] Tilt table tests are valuable for confirming the diagnosis.

• #24 Blackout/Transient Loss of Consciousness (T- LoC) and Syncope Epidemiology | STARS

  http://www.starstloc.org/why_set_up_a_t-loc_clinic/t-_loc_epidemiology

  According to the European Society of Cardiology Guidelines, identifying the cardiac causes of syncope is of critical importance, as many arrhythmias and other types of cardiac disease are now treatable with drugs and other devices. Some T-LoC can be a first symptom of fatal arrhythmia, which causes over 100,000 deaths every year in the UK. Sudden cardiac death is often attributed to cardiac arrhythmia and is today recognised as the most common killer in the US, accounting for around 350,000 deaths annually. Overall, event rates in Europe are similar to those in the United States, with significant geographic variations reported. Most sudden deaths in people under 30-years-old are caused by inherited cardiomyopathies and arrhythmias. Recurrent syncope impacts patients quality of life to the same degree as other chronic diseases such as rheumatoid arthritis. Syncope may result in injuries to the patients or to others as a result of accidents, leading to e.g. fractures.

• #25

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/syncope/

  The treatment for syncope varies based on the cause of syncope. While some causes are relatively benign, patients with frequent episodes of syncope occasionally need treatment. There are 2 main treatment strategies: conservative/nonpharmacologic therapy and medical treatment. […] Patients with syncope of unknown etiology and without underlying structural heart disease have a favorable outcome compared with those having organic heart disease. Response to treatment can be assessed by noting a patients overall improvement of symptoms, standing time, number of syncopal episodes per a defined period of time, extent of drop of blood pressure during standing, and time to drop of standing blood pressure.

• #26 Syncope – BroadcastMed

  https://www.broadcastmed.com/cardiology/6977/videos/syncope

  For a young patient, for an old patient, it’s still the most common cause of syncope, is neurally mediated syncope, or reflex syncope, or vasovagal syncope. […] Syncope does have some mortality. So at one year, 18% to 23% in patients that have cardiac syncope, they have a risk of dying, up to 1/5 risk, up to a 20% risk of dying in one year. And if you have a patient that’s gotten vasovagal syncope, their risk is the same as the general population. It’s very small. […] In summary, syncope common, up to 50%, 1/3 of the patients that we see are into– have vasovagal syncope. 1/3 of the patients that we see, we’re not going to have a reason for them to have syncope. We’re not going to find a reason.

• #27 Syncope After Vaccination — United States, January 2005–July 2007

  https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a2.htm

  Syncope (vasovagal reaction), or fainting, can be triggered by various stimuli, including medical procedures. Syncope has been documented to occur after vaccination, most commonly among adolescents, and can result in hospitalization for a medical evaluation or because of injury. The findings indicated that, since 2005, reports to VAERS regarding postvaccination syncope have increased, primarily among females aged 11–18 years, and rarely, subsequent serious injuries have occurred. To prevent syncope-related injuries, vaccine providers should follow the ACIP recommendation to strongly consider observing patients for 15 minutes after vaccination. […] VAERS, a passive surveillance system operated jointly by FDA and CDC, receives reports of vaccine adverse events (VAEs) and is designed to generate, not test, vaccine-safety hypotheses. Detecting new or rare VAEs, monitoring trends in known adverse events, and identifying risk factors for particular types of VAEs are the primary objectives of VAERS. Reports to VAERS typically involve multiple coding terms.

• #28 Top Published Expert Doctors for Vasovagal Syncope

  https://findexpertmd.com/d/Vasovagal_Syncope

  435 top medical experts on Vasovagal Syncope across 51 countries and 32 U.S. states, including 308 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials: at least 44 including 6 Active, 26 Completed, 5 Recruiting.

• #29 Pacing for Vasovagal Syncope | AER Journal

  https://www.aerjournal.com/articles/pacing-vasovagal-syncope-0?language_content_entity=en

  The 2018 ESC Guidelines for the Diagnosis and Management of Syncope consider pacing is reasonable for patients over 40 years old with spontaneous documented symptomatic asystolic pauses 3 seconds or asymptomatic pauses 6 seconds due to sinus arrest, AV block or a combination. […] Despite the trials outlined above, several knowledge gaps remain.

• #30 Vasovagal Syncope: A Review of Current and Future Strategies – touchCARDIOLOGY

  https://touchcardio.com/syncope/journal-articles/vasovagal-syncope-a-review-of-current-and-future-strategies/

  Recent European Society of Cardiology (ESC) guidelines recommend the use of tilt table testing in VVS (Class 2A) for confirming a diagnosis of reflex syncope (as well as other orthostatic intolerance syndromes) when suspected, but not confirmed. […] Overall principles of management: As a result of the psychosocial impairment and distress caused by recurrent syncope, and the resultant loss of quality of life, an empathetic, holistic, patient-based approach is a core tenet of care. […] Comprehensive multidisciplinary rehabilitation programmes for recurrent VVS have shown significant improvements in health-related quality of life, fewer recurrent syncopal episodes, plus fewer medical consultations, hospitalizations and traumatic injuries, compared with standard care. […] Many older patients with VVS are hypertensive and require hypotensive drugs; however, it has to be borne in mind that most hypotensive agents exaggerate vasodepression and may therefore increase attacks. […] There are encouraging results from systematic case series data in support of CNA. A highly selected, very symptomatic group of patients with dominant cardioinhibitory VVS could benefit from CNA, by either completely abolishing syncope, or extending the prodrome long enough to prevent injury.

• #31 An Experimental Model of Vasovagal Syncope Induces Cerebral Hypoperfusion and Fainting-Like Behavior in Awake Rats | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163280

  Despite VVS pathophysiology including the reductions in blood pressure and heart rate, VVS culminates in loss of consciousness, typically leading to a fall. […] To date, few clinical studies have been published measuring CBF before and during syncope. […] These studies, as well as the VVS paradigm, consider cerebral hypoperfusion as the primary sequelae of VVS. Therefore, an animal model of VVS must show reduction in cerebral blood flow during syncope. […] Herein we utilize the sGVS model in rats to examine its impact on CBF and, in awake animals, behavior changes caused by sGVS. […] Our first hypothesis is sGVS in rats results in decreased blood pressure and heart rate (HR), followed by reduced CBF, mimicking vasovagal response in humans. […] Our second hypothesis is sGVS in awake animals will induce VVS-like symptoms, namely fatigue followed by spontaneous fainting and recovery.

• #32 An Experimental Model of Vasovagal Syncope Induces Cerebral Hypoperfusion and Fainting-Like Behavior in Awake Rats | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163280

  Our third hypothesis is isoflurane preconditioning will induce cardio- and neuro-protective mechanisms, thereby attenuating the effects of sGVS on blood pressure, HR, and CBF. […] The sGVS model has been previously shown to cause lower MAP and HR in rats through activation of the vestibular neurons in the otolith organs. […] In that series of experiments, sGVS was found to cause rapid lowering of MAP and HR at stimulus amplitudes of 2-4 mA and frequencies of 0.008-0.4 Hz with the most effective stimulation frequency being 0.025 Hz. […] Herein, our findings support the findings that the optimal stimulation parameters for inducing vasovagal-like responses in rats is a 4 mA current at 0.025 Hz. Additionally, we found that not only is sGVS capable of producing the cardio-vascular depression that mimics human VVS, but sGVS also results in marked reduction of CBF.

• #33 Reflex syncope in adults and adolescents: Clinical presentation and diagnostic evaluation – UpToDate

  https://www.uptodate.com/contents/reflex-syncope-in-adults-and-adolescents-clinical-presentation-and-diagnostic-evaluation

  Vasovagal syncope is the most common cause of syncope in patients of all ages, and its diagnosis may usually be made by taking a careful history detailing the features of symptomatic events and identifying well-known triggers; however, a classic history is not always present, especially in older individuals. […] Even among patients with structural heart disease, especially if electrophysiology testing is nondiagnostic, approximately 60 percent of syncope episodes are reflex in origin. […] The clinical presentation and diagnostic evaluation of patients with vasovagal syncope and situational reflex syncope will be reviewed here. […] Understanding the pathophysiology involved in reflex syncope is essential to understanding its clinical manifestations and prevention strategies.

• #34 Transient loss of consciousness (TLoC) in primary care: a review of patients presenting with first blackout – The British Journal of Cardiology

  https://bjcardio.co.uk/2017/06/transient-loss-of-consciousness-tloc-in-primary-care-a-review-of-patients-presenting-with-first-blackout/

  The GPs in the study were generally good at recording the 3 Ps (posture, prodrome and provocation) that help to differentiate between vasovagal syncope and epilepsy (recorded in over 5576% of included patients where obtaining this information was possible). […] However, GPs were not as good at recording the red flags for syncope that would precipitate an urgent specialist assessment of the patient. […] Patients with cardiac syncope are at risk of higher mortality. […] This study suggests that there is a need for providing education for primary-care professionals regarding assessment of patients with blackouts, especially in relation to syncope red flags. […] Although the NICE guidance may be considered the standard that is used in primary care, it contains some deficiencies.

Zobacz więcej