Materiały źródłowe

• #1 Management and therapy of vasovagal syncope: A review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2998831/

  Vasovagal syncope is a common cause of recurrent syncope. […] This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. […] The cornerstone of therapy for young patients with vasovagal syncope remains education and reassurance, except in rare and isolated cases of patients with a high frequency of recurrent episodes despite nonpharmacological measures. […] In the elderly, specific treatment is often necessary. […] The main goal of treatment is to reduce syncope recurrence and physical trauma. […] Conditions triggering vasovagal reflexes should be avoided such as a hot environment, humid atmosphere, prolonged standing, and reduced water intake.

• #1 Vasovagal Syncope | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html

  Several triggers can cause vasovagal syncope. To help reduce the risk of fainting, you can stay away from some of these triggers, such as: […] If you can lie down at the first sign of these symptoms, you will often be able to prevent fainting. […] Watch for the warning signs of vasovagal syncope, like dizziness, nausea, or sweaty palms. If you have a history of vasovagal syncope and think you are about to faint, lie down right away. Tensing your arms or crossing your legs can help prevent fainting. Passively raising or propping up your legs in the air can also help. […] If you have had episodes of vasovagal syncope, your healthcare provider might make some suggestions on how to help prevent fainting. These might include: […] Occasionally, you may need medicine to help control vasovagal syncope. However, research on these medicines has revealed uncertain benefits in vasovagal syncope.

• #1 Vasovagal Syncope

  https://johnshopkinshealthcare.staywellsolutionsonline.com/Library/DiseasesConditions/Adult/134,592

  Vasovagal syncope is a condition that leads to fainting in some people. […] To help reduce the risk of fainting, you can stay away from some of these triggers, such as: Standing for long periods, Excess heat, Intense emotion, such as fear, Intense pain, The sight of blood or a needle, Prolonged exercise, Dehydration, Skipping meals. […] If you can lie down at the first sign of these symptoms, you will often be able to prevent fainting. […] Watch for the warning signs of vasovagal syncope, like dizziness, nausea, or sweaty palms. If you have a history of vasovagal syncope and think you are about to faint, lie down right away. Tensing your arms or crossing your legs can help prevent fainting. Passively raising or propping up your legs in the air can also help. […] If you have had episodes of vasovagal syncope, your healthcare provider might make some suggestions on how to help prevent fainting. These might include: Avoiding triggers, such as standing for a long time or the sight of blood, Moderate exercise training, Discontinuing medicines that lower blood pressure, like diuretics, Eating a higher salt diet, to help keep up blood volume, Drinking plenty of fluids, to maintain blood volume, Wearing compression stockings or abdominal binders. […] Occasionally, you may need medicine to help control vasovagal syncope. […] Most people with occasional vasovagal syncope need to make only lifestyle changes, such as drinking more fluids and eating more salt.

• #1 Usefulness of Physical Maneuvers for Prevention of Vasovagal Syncope

  https://www.jstage.jst.go.jp/article/circj/69/9/69_9_1084/_article

  It is known that approximately two-thirds of patients with vasovagal syncope have prodromal symptoms and when these start, physical maneuvers that can increase venous return may abort the syncopal attack. […] The aims of this study were to evaluate the effects of 3 physical maneuvers, squatting, leg-crossing with muscle tensing, and handgrip, on improving hemodynamic status, and to compare the effect of each on aborting or preventing vasovagal syncope. […] Squatting and leg-crossing with muscle tensing improved the hemodynamics of normal subjects as well as those of patients with vasovagal syncope. Squatting and leg-crossing can be used as a simple and effective preventive maneuver in patients with vasovagal syncope.

• #1 Vasovagal Syncope: What to Do When First-Line Measures Are Not Enough

  https://consultqd.clevelandclinic.org/vasovagal-syncope-what-to-do-when-first-line-measures-are-not-enough

  The effectiveness of counter-pressure maneuvers was studied by van Dijk et al in a multicenter prospective randomized clinical trial that included 223 patients with recurrent vasovagal syncope associated with prodromal symptoms. They concluded that these maneuvers decreased the recurrence of syncopal episodes, with a relative risk reduction of 0.36 (95% confidence interval, 0.11-0.53; P .005) and were low-cost and risk-free. […] […] The evidence for increasing salt and fluid intake for patients with vasovagal syncope is limited. But in the absence of a contraindication such as hypertension, renal disease or heart failure, it may be reasonable to encourage the ingestion of 2 to 3 liters of fluid per day and a total of 6 to 9 grams of salt per day (around one to two heaping teaspoons of salt). […]

• #1 How to Avert a Vasovagal Episode | envisionsrh

  https://www.envisionsrh.com/how-to-avoid-vasovagal

  Best practice: give your clients anticipatory guidance so they can prevent their own vasovagal reactions! […] Essential Point Vasovagal reactions are common, scary, and preventable. Tensing the muscles of the arms, hands, feet, and legs can instantly stop a vasovagal reaction and prevent fainting. […] 1 Simple Step: Stop the Vasovagal Reaction! Isometric contraction of the muscles of the hands, arms, hands, feet, and legs can immediately stop the vasovagal reaction in its tracks and prevent fainting. […] If they say yes, let them know that they can prevent it from happening again by contracting the muscles in the extremities as soon as they notice it starting. […] Be Alert for Signs of an Impending Vasovagal Response If you havent talked with your client about how to prevent a vasovagal reaction beforehand, watch for signs and symptoms of a vasovagal.

• #1 Management of recurrent vasovagal syncope by means of isometric counterpressure manoeuvres

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-2/Management-of-recurrent-vasovagal-syncope-by-means-of-isometric-counterpressure

  Isometric arm and leg exercises are able to increase blood pressure during the phase of impending vasovagal syncope. The patients trained to their use will be able to enact physical manoeuvres and relieve symptoms in most cases of occurrence of symptoms of impending syncope during their daily life. […] Acute tilt studies (1,2) showed that isometric manoeuvres of the arms or of the legs are able to induce an abrupt significant blood pressure increase during the phase of impending vasovagal syncope, which is already evident after 10 s, and allow the patient to avoid or delay losing consciousness in most cases. […] Three manoeuvres have been validated. Arm-tensing consists of the maximum tolerated isometric contraction of the two arms achieved by gripping one hand with the other and contemporarily abducting (pushing away) the arms.

• #1 Vasovagal syncope – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527

  You may not always be able to avoid a vasovagal syncope episode. If you feel like you might faint, lie down and lift your legs. This allows gravity to keep blood flowing to your brain. If you can’t lie down, sit down and put your head between your knees until you feel better.

• #1 Vasovagal Syncope: Symptoms, Causes, and Treatments

  https://www.verywellhealth.com/vasovagal-cardioneurogenic-syncope-1746389

  If you’ve had one or two episodes of vasovagal syncope, you’ve probably learned to spot the warning signs. You may even be able to prevent an episode by lying down and elevating your legs. […] The best thing you can do to prevent fainting is to avoid your triggers—for example, excessive heat, stress, dehydration, pain, and prolonged standing. […] If you have low blood pressure, consider talking to your provider about whether increasing your salt intake could help you avoid fainting episodes.

• #1 What Are the Symptoms of Vasovagal Syncope?

  https://www.icliniq.com/articles/diseases-and-disorders-common-medical-conditions/vasovagal-syncope

  Eat nutritious food and drink plenty of water. – Increase the dietary salt amount. – Avoid triggers such as stress and anxiety. – Stop taking medicines that lower your blood pressure, such as – Furosemide. – Practice mindfulness practices such as yoga and meditation to prevent stress and learn to balance stressful situations.

• #1 Vasovagal Syncope: Causes, Symptoms, Treatment & Prevention

  https://www.apollohospitals.com/diseases-and-conditions/vasovagal-syncope-causes-symptoms-diagnosis-prevention-treatment

  Vasovagal syncope is not entirely preventable in all cases. But a person can work towards reducing the number of fainting episodes they experience. Below are some recommendations for the prevention of VVS episodes and the related complications. […] Identify and avoid conditions that trigger fainting episodes […] Exercise […] Drink lots of fluids for maintaining your blood volume […] Consume a healthy diet, which has adequate salt […] Wear compression stockings […] Stop medications that can lower your blood pressure […] Do not suddenly sit or lie down when feeling dizzy.

• #1 Neurocardiogenic Syncope: A Focus on the Management of Vasovagal Episodes

  https://www.uspharmacist.com/article/neurocardiogenic-syncope-a-focus-on-the-management-of-vasovagal-episodes

  In addition, the use of waist-high support stockings with a minimum of 30 mmHg ankle counterpressure may help decrease and prevent syncopal episodes. […] Medication reviews should also be performed in order to recognize, reduce, or withdraw those that can precipitate a syncopal event. Specifically, the discontinuation of angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, long-acting nitrates, and diuretics in patients experiencing vasovagal syncope has been associated with a reduction of positive tilt-table test results. […] A number of pharmacologic agents have shown some promise in the management of neurocardiogenic syncope; however, none currently possesses approval for this indication by the FDA. Some of the more common pharmacologic agents used in the management and prevention of this condition include beta-adrenergic receptor blockers (beta-blockers), selective serotonin reuptake inhibitors (SSRIs), mineralocorticoids, and vasoconstrictors.

• #1 Can Exercise Prevent Vasovagal Syncope?

  https://www.icliniq.com/articles/diseases-and-disorders-common-medical-conditions/preventing-vasovagal-syncope

  Exercise can have both positive and negative effects on syncope (fainting) risk: […] Regular exercise strengthens the heart and improves blood vessel function, reducing the likelihood of sudden drops in blood pressure. […] Exercise can help regulate the autonomic nervous system, potentially reducing the triggers for vasovagal syncope. […] Physical activity can lead to an expansion of blood volume, making it less likely for syncope to occur due to insufficient blood supply to the brain. […] Staying well-hydrated is crucial to prevent exercise-induced syncope. […] Lifestyle adjustments can be effective in managing syncope (fainting). Here are some key changes that can help: […] Maintaining adequate fluid intake can prevent syncope related to dehydration. […] Increased salt consumption can help raise blood pressure and reduce syncope risk.

• #1 Vasovagal Syncope: What to Do When First-Line Measures Are Not Enough

  https://consultqd.clevelandclinic.org/vasovagal-syncope-what-to-do-when-first-line-measures-are-not-enough

  In patients who continue to have syncopal episodes despite adequate use of first-line measures, medical therapy can be considered. Unfortunately, evidence supporting drug therapy for recurrent syncope is limited. Options include midodrine (class IIa), fludrocortisone (class IIb), beta-blockers (class IIb) and selective serotonin reuptake inhibitors (class IIb). […] […] Midodrine has the strongest recommendation and is a reasonable option if there is no history of hypertension, heart failure or urinary retention. It is a peripheral alpha-agonist that ameliorates the reduction in peripheral sympathetic neural outflow responsible for venous pooling and vasodepression in vasovagal syncope. […] […] Fludrocortisone results in increased blood volume due to mineralocorticoid activity. In the Prevention of Syncope Trial 2 of fludrocortisone versus placebo, patients on fludrocortisone had a marginally nonsignificant reduction in recurrence of syncope over one year (hazard ratio = 0.69; P = .069). […]

• #1 Midodrine Is Worth a Trial in People With Frequent Episodes of Vasovagal Syncope | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0400/od4.html

  Midodrine is a vasoconstrictor used to prevent orthostatic hypotension and may reduce the likelihood of recurrence of vasovagal syncope in patients with frequent episodes. […] Over one year, 58% of patients in the midodrine group were syncope-free compared with 39% in the placebo group (number needed to treat = 5). […] Midodrine was associated with a longer time to first recurrence of syncope (P = .035).

• #1 Vasovagal Syncope: What to Do When First-Line Measures Are Not Enough

  https://consultqd.clevelandclinic.org/vasovagal-syncope-what-to-do-when-first-line-measures-are-not-enough

  Overall, beta-blockers have failed to prevent syncope in randomized controlled trials. But in a meta-analysis that included patients from the Prevention of Syncope Trial, an age-dependent benefit of beta-blockers was noted in patients age 42 and older. Therefore, a beta-blocker may be a reasonable option in patients in this age group with recurrent vasovagal syncope. […] […] Orthostatic training with repetitive tilt-table testing until a test is negative, or with daily standing quietly against a wall for prolonged periods has not been shown to have sustained benefit in reducing the recurrence of syncopal episodes (class IIb recommendation). […] […] Dual-chamber pacing can be considered in carefully selected patients age 40 or older with syncope and documented asystole of at least 3 seconds or spontaneous pauses of at least 6 seconds without syncope on implantable loop recorder monitoring (class IIb recommendation). Strict patient selection increases the likelihood that pacing will be effective. […]

• #1 POST: The Prevention of Syncope Trial. A Randomized Clinical Trial of Metoprolol in the Prevention of Vasovagal Syncope

  https://www.medscape.com/viewarticle/480390

  At 1 year, metoprolol was not associated with any benefit over placebo for the prevention of syncopal recurrence (efficacy analysis). […] Investigators drew the following conclusions from their POST study results: There is no significant benefit from metoprolol in the population at large. […] Patients 42 years of age taking metoprolol have a 59% relative risk reduction in syncope. […] Metoprolol can be considered a first-line treatment for vasovagal syncope in patients 42 years of age, but it is not a suitable first-line treatment for younger patients.

• #1 Management and therapy of vasovagal syncope: A review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2998831/

  A reduction or cessation of vasoactive substances may be necessary. […] Discontinuation of hypotensive drug treatment for concomitant conditions is an important first line measure for the prevention of syncope recurrences in many subjects, especially in older patients. […] Patients should be motivated to identify prodromals of syncope. […] Furthermore counterpressure maneuvers such as hand-grip and leg crossing may inhibit vasovagal syncope by increasing the venous return. […] A number of drugs have been tested in the treatment of vasovagal syncope. […] Midodrine may be indicated in patients with frequent vasovagal syncope refractory to lifestyle measures. […] Some open-label studies and one randomized, placebo-controlled trial demonstrated that SRI may reduce recurrent vasovagal syncope. […] The role of cardiac pacing is controversial. […] Given a IIa/B classification by the European Society of Cardiology, pacemaker implantation may play a role in special circumstances.

• #1 Pacing for Vasovagal Syncope | AER Journal

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

  The 2008 American College of Cardiology/American Heart Association (ACC/AHA) Pacemaker Guidelines gives a class IIb indication for pacing for symptomatic neurocardiogenic syncope associated with bradycardia documented spontaneously or by tilt-table test. […] 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. […] The ongoing Benefit of Dual Chamber Pacing with Closed Loop Stimulation (CLS) in Tilt-induced Cardioinhibitory Reflex Syncope (BIOSync CLS) study will compare dual-chamber DDD-CLS pacing with placebo. […] The fact that pacing can be effective in some patients with syncope does not mean that it is required for all patients. […] However, younger patients with frequent, debilitating, recurrent asystolic vasovagal syncope unresponsive to any other therapy or unable to be treated in any other way may indeed be candidates for pacing.

• #1 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/

  Pacemaker therapy in VVS remains controversial. […] The hearts intrinsic autonomic innervation consists of a complex network of ganglia and nerves that lie on the epicardial surface usually embedded within the epicardial fat. […] 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.

• #1 Fainting and Vaccines | Vaccine Safety | CDC

  https://www.cdc.gov/vaccine-safety/about/fainting.html

  Fainting itself is generally not serious, but harm from related falls or other accidents can cause injury. The main concern is head injury. […] However, many falls due to fainting can be prevented by having the patient sit or lie down. For this reason, experts recommend having patients sit in a chair or lay down when they receive a vaccination. In addition, patients should be observed for 15 minutes after vaccination. […] If a patient does faint after a vaccination, she or he should be observed by medical personnel until she or he regains consciousness so that further treatment needs can be determined.

• #1 Prevention Of Vasovagal Syncope During Venipuncture

  https://www.ivteam.com/intravenous-literature/vascular-access/prevention-of-vasovagal-syncope-during-venipuncture/

  „Use of the lidocaine tape was successful and permitted comfortable placement of the IV catheter without any onset of VVS” Shiraishi et al (2023). […] We determined that pain was the main trigger of VVS for these patients and attempted to reduce venipuncture-associated pain using 60% lidocaine tape applied 3 hours before venipuncture at their next dental visits, respectively. […] Use of the lidocaine tape was successful and permitted comfortable placement of the IV catheter without any onset of VVS.

• #1 Vasovagal Reactions during Interventional Pain Management Procedures—A Review of Pathophysiology, Incidence, Risk Factors, Prevention, and Management

  https://www.mdpi.com/2076-3271/10/3/39

  Some evidence suggests that moderate sedation might reduce risk of vasovagal reaction, especially in patients with a history of vasovagal reactions. […] The possibility of using sedation, anxiolysis, or antimuscarinic agents to prevent vasovagal reactions raises the question of whether an IV line with fluids running should be placed prior to interventional pain management procedures. […] For these reasons, some have advised obtaining IV access prior to interventional pain management procedures for patients with a high risk of vasovagal syncope. […] However, no studies to our knowledge have evaluated whether IV fluid administration during interventional pain management procedures can prevent vasovagal reactions. […] Mahajan 2008 recommends giving IV glycopyrrolate in increments of 0.2 mg for prevention of vasovagal syncope during interventional pain management procedures for patients with a history of vasovagal episodes, but did not provide references to support his recommendation.

• #1 Effect of psychotherapy on recurrence of events and quality of life in patients with vasovagal syncope | Scientific Reports

  https://www.nature.com/articles/s41598-022-09513-1

  Emotional distress is related to recurrence of syncope compromising patient’s quality of life (QoL). […] The aim of this study was to determine if weekly sessions of psychotherapy reduce recurrence of events and improve QoL by SF-36 among patients with refractory vasovagal syncope. […] In conclusion, patients with refractory vasovagal syncope undergoing regular psychotherapeutic intervention had less recurrence of events and improved their quality of life in 1 year. […] General measures, such as increase in salt and water intake and lifestyle interventions like exercises, tilt training and counter pressure maneuvers are usually recommended in order to avoid recurrences. […] Psychological approach is frequently mentioned as a possible intervention to improve symptoms, but there is a lack of randomised clinical trials evaluating the specific effect of regular psychotherapy sessions among patients with recurrent refractory VVS.

• #1 Textbook | Vasovagal Syncope | Syncopedia

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

  In vasovagal syncope, recognizing the diagnosis is the first part of the treatment. As it is an episodal event, most patients dont need more than a few lifestyle measures to learn how to prevent the vasovagal faints. […] By tensing the abdominal muscles and the muscles in the extremities the venous return can be increased almost instantaneously. This can be done by whole body muscle tensing or by leg crossing and tensing the calves. Prodromes have to be present, otherwise the counter pressure manoeuvres can not be applied in time to prevent the faint. This makes this a very useful method under the younger population, as they have prodromes most of the time. In older patients, prodromes are often absent, and physical counterpressure manoeuvres and thus not a good intervention in these patients.

• #1 Treatment Options for Vasovagal Syncope: A Clinical Dilemma

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/02/10/13/41/Treatment-Options-for-Vasovagal-Syncope

  Some younger patients may „outgrow” the vasovagal reflex over time, as there is a spike in the incidence of vasovagal syncope in younger women; thus, the need for aggressive intervention should be reserved for those few patients with refractory and severe episodes that cannot be predicted and that have a substantial impact on quality of life.

• #1 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. […] In this review, we highlight the increasing recognition that the condition is multifactorial, and emphasize and discuss multifaceted management approaches, including education, psychological wellbeing, dietary and fluid intake, pharmacotherapy and cardiac intervention. […] 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. […] Education about physical counter-manoeuvres, and exercise training.

• #2 Vasovagal Syncope: What to Do When First-Line Measures Are Not Enough

  https://consultqd.clevelandclinic.org/vasovagal-syncope-what-to-do-when-first-line-measures-are-not-enough

  Vasovagal syncope is usually benign, and although it often recurs, increasing fluid and salt intake and performing counter-pressure maneuvers are usually sufficient. However, if patients continue to have syncopal episodes despite these first-line measures, other options include drug therapy with midodrine, fludrocortisone, beta-blockers or selective serotonin reuptake inhibitors, as well as orthostatic training and, in some cases, pacemaker implantation. The 2017 guidelines from the American College of Cardiology, American Heart Association and Heart Rhythm Society (ACC/AHA/HRS) are helpful in the management of these patients. […] […] Initial measures include performing physical counter-pressure maneuvers (class IIa), increasing salt and fluid intake (class IIb) in the absence of contraindications and, in selected patients, reducing or withdrawing hypotensive medications when appropriate (class IIb). […]

• #2 Treatment Options for Vasovagal Syncope: A Clinical Dilemma

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/02/10/13/41/Treatment-Options-for-Vasovagal-Syncope

  This patient is having occasional episodes of vasovagal syncope. […] Importantly, it is a benign condition and patient education on its benign nature and education on avoidance of triggers is the only current Class I recommendation in the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.1 […] Patient education regarding the benign nature of vasovagal syncope and avoidance of triggers to reduce episodes is the first-line recommended therapy. […] Counterpressure maneuvers (leg crossing, squatting, etc.) have been shown to reduce episodes of syncope, particularly if there is a prolonged prodrome. […] Increased fluid intake and salt consumption are also frequently advised; however, these have also not been studied in placebo-controlled trials and evidence supporting this conservative approach is weak.

• #2 Vasovagal syncope – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/diagnosis-treatment/drc-20350531

  In most cases of vasovagal syncope, treatment is unnecessary. Your healthcare professional may help you understand your fainting triggers and discuss ways you might avoid them. […] If vasovagal syncope interferes with your quality of life, your healthcare professional may suggest trying one or more of the following remedies: […] A drug called fludrocortisone acetate that’s usually used to treat low blood pressure may be helpful in preventing vasovagal syncope. Selective serotonin reuptake inhibitors also may be used. […] Your healthcare professional may recommend ways to lessen the pooling of blood in your legs. These may include foot exercises, wearing compression stockings or tensing your leg muscles when standing. You may need to increase salt in your diet if you don’t usually have high blood pressure. Avoid prolonged standing especially in hot, crowded places and drink plenty of fluids. […] Very rarely, inserting an electrical pacemaker to regulate the heartbeat helps some people with vasovagal syncope who haven’t been helped by other treatments.

• #2 Vasovagal Syncope: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/23325-vasovagal-syncope

  You may be able to prevent vasovagal syncope episodes by drinking more fluids, eating more salt and standing up slowly. Talk with your provider before you increase your salt intake, as it increases your blood pressure. […] Many people who have vasovagal syncope can limit its impact on their lives. They can learn to recognize the symptoms of a vasovagal syncopal episode and avoid known triggers. Knowing what it feels like before you have an episode can allow you to lie on your back or sit so you dont get hurt if you fall. […] If you can recognize an episode before it happens, you may be able to stop it. Your healthcare provider can teach you techniques that keep your blood pressure high enough so that you dont pass out. These include: squeezing a foam or rubber ball. Clenching your fist like this may help you stay conscious. Arm-tensing. Curl both of your hands like youre holding something, interlocking your fists. With one hand facing palm-down and the other facing palm-up, hook your curled hands together. Try to pull them apart. Leg-crossing. While standing, cross your legs so one knee is behind the other. Keep your balance and then tense up the muscles in your legs, belly and butt.

• #2 Management of recurrent vasovagal syncope by means of isometric counterpressure manoeuvres

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-2/Management-of-recurrent-vasovagal-syncope-by-means-of-isometric-counterpressure

  Patients are instructed to maintain the manoeuvre they choose as long as possible and eventually move on to the second manoeuvre if useful. […] In general, initial treatment of all forms of neurally-mediated reflex syncope comprises education regarding avoidance of triggering events (e.g., hot crowded environments, volume depletion, effects of cough, tight collars, etc.), recognition of premonitory symptoms, and manoeuvers to abort the episode. Non-pharmacological physical treatments are arising as a new first choice treatment of vasovagal syncope in patients who have vasovagal syncope preceded by prodromal symptoms and age 65 years. […] In 2 follow-up studies (1,2), the manoevres were self-administered by these patients in 95% of cases and were able to abort syncope in 95% of patients. The treatment was easy to perform, reliable, safe and well accepted by the patients, who expressed good satisfaction.

• #2 Textbook | Vasovagal Syncope | Syncopedia

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

  The goal of drinking enough water and eating salt is to increase the central blood volume and prevent a vasovagal reaction. When building a history with the patient, be sure to ask about their water and salt intake. Patients with frequent episodes of (pre)syncope should at least drink 3 L of water every day and they should always have clear urine. Eating more salt increases central blood volume but also increases the overall blood pressure. When advising a patient to increase their salt intake, be sure to take notice of the blood pressure of the patient.

• #2 Metoprolol for the prevention of vasovagal syncope

  https://www.hcplive.com/view/august-2006-baggs

  The need for isoproterenol to evoke a vasovagal response during tilt testing was not useful in predicting a favorable response to metoprolol. […] Thus, older age was not predictive of a beneficial effect from metoprolol. […] Metoprolol and possibly other beta-adrenergic blockers have no role as first-line therapy in the majority of patients with vasovagal syncope. […] The failure to show an effect with metoprolol should prompt a reevaluation of current theories of syncope physiology that feature a role for beta-adrenergic stimulation. […] Metoprolol was not shown to be effective in reducing the burden of syncope symptoms. […] Furthermore, neither age nor response to isoproterenol was useful in selecting which patients might benefit from metoprolol.

• #2 Vasovagal Syncope: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/vasovagal-syncope

  Vasovagal syncope doesn’t necessarily call for treatment. But it’s a good idea to try avoid those situations that trigger fainting and take measures to prevent injury due to falling. […] It may not be possible to completely prevent vasovagal syncope, but you may be able to cut down on how often you faint. […] The most important step is to try and determine your triggers. […] If you’re able to find a pattern, try to take steps to avoid or work around your triggers. […] When you start to feel faint, immediately lie down or sit in a safe spot if you can. It could help you avoid fainting, or at least prevent injury due to a fall.

• #2 Vasovagal Syncope | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html

  Several triggers can cause vasovagal syncope. To help reduce the risk of fainting, you can stay away from some of these triggers, such as: […] If you can lie down at the first sign of these symptoms, you will often be able to prevent fainting. […] Watch for the warning signs of vasovagal syncope, like dizziness, nausea, or sweaty palms. If you have a history of vasovagal syncope and think you are about to faint, lie down right away. Tensing your arms or crossing your legs can help prevent fainting. Passively raising or propping up your legs in the air can also help. […] If you have had episodes of vasovagal syncope, your healthcare provider might make some suggestions on how to help prevent fainting. These might include: […] Occasionally, you may need medicine to help control vasovagal syncope. However, research on these medicines has revealed uncertain benefits in vasovagal syncope.

• #2 Midodrine for Prevention of Vasovagal Syncope

  https://www.acc.org/latest-in-cardiology/journal-scans/2021/08/10/16/37/midodrine-for-the-prevention

  Midodrine for the Prevention of Vasovagal Syncope […] Oral midodrine significantly decreased the proportion of recurrent syncope, in young healthy individuals with vasovagal syncope, when it was administered in conjunction with guideline-directed teaching about lifestyle risk reduction. […] The authors concluded that midodrine can reduce the recurrence of syncope in healthy, younger patients with a high syncope burden. […] Although this study comprises a small sample size and the follow-up period was about 12 months, the findings are important because midodrine may be helpful in one out of five patients with recurrent syncope. […] Until more data are available, the findings of this study suggest that midodrine will be an important therapeutic option in the management of recurrent syncope.

• #2 Clinical Trial for the Prevention of Vasovagal Syncope

  https://ctv.veeva.com/study/clinical-trial-for-the-prevention-of-vasovagal-syncope

  The main question in the study is whether people taking fludrocortisone are less likely to faint than people taking an inactive pill called a placebo. […] There is ample evidence of the importance of blood volume in the pathophysiology of vasovagal syncope. […] Blood volume expansion with either dietary salt supplementation or fludrocortisone is often recommended by clinicians for the treatment of vasovagal syncope despite a paucity of good evidence for their efficacy. […] Four clinical studies suggest its utility in the prevention of syncope. […] Fludrocortisone might decrease the incidence of vasovagal syncope, but the quality of the evidence supporting its use is poor. […] There are no randomized, placebo-controlled trials of fludrocortisone for the prevention of vasovagal syncope. […] In this 5-year study the investigators will test the hypothesis that fludrocortisone prevents recurrences of vasovagal syncope.

• #2 Metoprolol for the prevention of vasovagal syncope

  https://www.hcplive.com/view/august-2006-baggs

  Metoprolol was not shown to be effective in reducing the burden of syncope symptoms. […] Few therapies have been proven to prevent vasovagal syncope in large, randomized clinical trials. […] The intention-to-treat analysis showed no significant difference in treatment failure, defined as syncope or treatment discontinuation, in those taking metoprolol compared with those taking placebo. […] There was no benefit from metoprolol, therefore, in preventing syncope in the population as a whole. […] The POST showed that patients with vasovagal syncope received no benefit from metoprolol. […] These findings are in agreement with some studies but not all that have investigated the effectiveness of beta-blocker therapy in reducing the frequency of syncope symptoms. […] On the whole, there is little evidence that beta blockers help patients with vasovagal syncope.

• #2

  https://link.springer.com/article/10.1007/s10286-023-01000-5

  Vasovagal syncope is a common clinical condition that lacks effective medical therapies despite being associated with significant morbidity. Current guidelines suggest that serotonin-specific reuptake inhibitors might suppress vasovagal syncope but supporting studies have been small and heterogenous. The purpose of this study was to evaluate the efficacy of serotonin-specific reuptake inhibitors to prevent syncope in patients with recurrent vasovagal syncope by conducting a systematic review and meta-analysis of published studies. […] Serotonin-specific reuptake inhibitors were found to substantially reduce the likelihood of a patient having at least one recurrence of vasovagal syncope [relative risk (RR) 0.34 (0.200.60), p0.01] with minimal between-study heterogeneity (I2=0%, p=0.67). […] Serotonin-specific reuptake inhibitors may be effective in preventing syncope induced by head-up tilt testing and in syncope in the community in randomized, double-blinded clinical trials.

• #2 What can I do when first-line measures are not enough for vasovagal syncope? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/12/920

  In patients who continue to have syncopal episodes despite adequate use of first-line measures, medical therapy can be considered. Unfortunately, evidence supporting drug therapy for recurrent syncope is limited. Options include midodrine (class IIa), fludrocortisone (class IIb), beta-blockers (class IIb), and selective serotonin reuptake inhibitors (class IIb). […] […] Orthostatic training, with repetitive tilt-table testing until a test is negative, or with daily standing quietly against a wall for prolonged periods of time, has not been shown to have sustained benefit in reducing the recurrence of syncopal episodes (class IIb recommendation). […]

• #2 How to Prevent Fainting: Ways to Avoid Passing Out

  https://www.healthline.com/health/how-to-prevent-fainting

  If youre prone to fainting or have a condition that makes you more likely to faint, there are steps you can take to help reduce your risk of passing out. […] Ways to prevent fainting: Eat regular meals, and avoid skipping meals. If you feel hungry between meals, eat a healthy snack. Make sure you drink enough water every day. If you need to stand in one place for a long time, be sure to move your legs and dont lock your knees. Pace if you can, or shake your legs out. If youre prone to fainting, avoid exerting yourself in hot weather as much as possible. If youre prone to anxiety, find the coping strategy that works for you. You can try regular exercise, meditation, talk therapy, or many other options. If you have sudden anxiety and feel like you might faint, take slow breaths and count slowly to 10 to try to calm yourself. Take any medications as prescribed, especially for diabetes or cardiovascular issues. If you feel dizzy or lightheaded from taking a medication, let your doctor know. They may be able to find a different medication for you that doesnt cause this side effect. If you faint while giving blood or getting a shot, make sure you drink plenty of fluids and eat a meal a few hours beforehand. While youre giving blood or getting the shot, lie down, dont look at the needle, and try to distract yourself.

• #2 Effect of psychotherapy on recurrence of events and quality of life in patients with vasovagal syncope | Scientific Reports

  https://www.nature.com/articles/s41598-022-09513-1

  The results could be interpreted as a proof of concept of benefit of this type of psychotherapy in recurrent vasovagal syncope. […] This promising alternative of adjunct therapy is relevant for clinical practice in refractory cases of VVS, since the current options for this population, including pharmacologic treatment, have limited benefit. […] In this randomised, pilot, open-label, controlled trial, patients with recurrent refractory vasovagal syncope that underwent regular psychotherapeutic intervention had significant reduction in the recurrence of events and an improvement on quality of life during 1 year of follow-up.

• #2 What can I do when first-line measures are not enough for vasovagal syncope? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/85/12/920

  Vasovagal syncope is usually benign, and although it often recurs, increasing fluid and salt intake and performing counter-pressure maneuvers are usually sufficient. However, if patients continue to have syncopal episodes despite these first-line measures, other options include drug therapy with midodrine, fludrocortisone, beta-blockers, or selective serotonin reuptake inhibitors; orthostatic training; and, in some cases, pacemaker implantation. The 2017 guidelines from the American College of Cardiology, American Heart Association, and Heart Rhythm Society (ACC/AHA/HRS) are helpful in the management of these patients. […] […] Initial measures include performing physical counter-pressure maneuvers (class IIa), increasing salt and fluid intake (class IIb) in the absence of contraindications, and, in selected patients, reducing or withdrawing hypotensive medications when appropriate (class IIb). […]

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