Chapter 6. Vasovagal syncope

What is vasovagal syncope

A short-term loss of consciousness with vasovagal syncope occurs when a person takes an upright position. Such phenomena occur due to stimulation of the vagus nerve, which innervates the chest, neck and intestines.

Vasovagal syncope occurs when a person is in an upright position at a time when, due to stimulation of the vagus nerve, the lumen of the blood vessels dilates and the pulse rate decreases.

The cause is usually stress, severe emotional shock, hunger, and external influences.

For differential diagnosis of serious diseases, a comprehensive examination is carried out, including 24-hour monitoring of heart function.

Treatment is aimed at combating the cause of fainting.

Like other types of fainting, vasovagal fainting develops against the background of a sharp decrease in blood flow to the brain due to the influence of a number of provoking factors: stress, nervous tension, fear, and others.

Loss of consciousness occurs due to the fact that the described processes contribute to the dilation of blood vessels, which leads to a decrease in blood pressure and heart rate (bradycardia). As a result, the brain experiences oxygen starvation.

If you notice symptoms of impending vasovagal syncope, you should lie down and loosen tight clothes, a tie, or a belt.
In most cases, the person immediately feels better. To speed up recovery, you can raise your legs above your head.

Neurologist, reflexologist, hirudotherapist

Kislitsyna Ekaterina Nikolaevna

10 years of experience

Treatment for vasovagal syncope

If it were not for the danger of injury, then treating the problem would not make sense. But given these conditions, treatment is necessary.

There are three types of treatment, namely:

Medication. The drug of choice is midodrine. Therapy lasts a lifetime, although it may be stopped for short periods of time.

Behavioral. It involves the use of some physical maneuvers, which should be resorted to when the first symptoms appear. These are isometric compression exercises that can cause an increase in blood pressure in the initial phase of fainting.

Three types of exercises are used, namely:

• Squeezing the ball. Strong clenching of a fist, for example, a ball. Promotes the outflow of venous blood from the brain.
• Arm tension. Hands are clasped and pulled in different directions.
• Leg compression. The legs are placed crosswise, as shown in the figure, and tensed.

Surgical. It involves the installation of a pacemaker, which normalizes the heartbeat, reducing the likelihood of fainting. This treatment is, of course, used after careful evaluation and only in cases where other means have failed.

Kinds

In medicine, it is customary to divide vasovagal syncope into two types.

Classical

Loss of consciousness is accompanied by phenomena characteristic of other types of fainting states. Most often, the classic type occurs against the background of emotional disturbances (fear, strong emotions, etc.), or prolonged stay in an upright position. It is detected mainly in young people under 30 years of age.

Non-classical

This type of vasovagal syncope is diagnosed in cases where it is impossible to determine the provoking factor. Loss of consciousness in this scenario occurs mainly in older people.

Causes

The main cause of vasovagal syncope is an abnormal reaction of the body to the influence of the external environment, which has a stimulating effect on the receptors of the autonomic nervous system. The latter is responsible for the functioning of internal organs.

Modern medicine has not fully elucidated the question of what changes in the body lead to loss of consciousness. Vasovagal syncope is thought to develop due to stimulation of the vagus nerve. This theory is supported by the fact that when such conditions occur, the heart rate decreases.

There is also an opinion that instantaneous inhibition of the sympathetic part of the nervous system, which regulates the autonomic system, can lead to loss of consciousness. This explains why blood vessels dilate during fainting.

Moreover, each of the processes described above is activated under the influence of one or more provoking factors:

• strong emotional stress arising from the sight of blood, due to fear, and so on;
• pain ;
• staying upright for a long period of time;
• abrupt cessation of physical exercise;
• wearing tight ties or collars;
• binge eating;
• long stay in a stuffy room, in a hot bath;
• dieting , fasting;
• abuse of bad habits;
• chronic state of fatigue;
• depression;
• heart pathologies;
• tumor formations.

People suffering from cardiovascular diseases are strongly advised not to stay in hot rooms or in direct sunlight for long periods of time. This situation contributes to impaired blood flow, resulting in changes in blood pressure.

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Fainting due to prolonged fasting is caused by a lack of vitamins and microelements. The latter leads to a decrease in hemoglobin and blood sugar levels, resulting in a malfunction of internal systems.

Under the influence of stress of a different nature (physical and psycho-emotional), the body, trying to compensate for the lack of important elements, temporarily inhibits some of its functions.

Any bad habits negatively affect the condition of blood vessels, which increases the risk of malfunctions in the cardiovascular system. The result of such processes is vasovagal syncope. Similar phenomena occur with chronic lack of sleep and fatigue. In this case, fainting performs a compensatory function of the body, whose blood flow is disrupted.

Vasovagal syncope is only dangerous when there is a risk of injury to the head and limbs from a fall. In this case, sudden memory loss signals a malfunction in the functioning of the entire organism or its individual parts.

Symptoms

The development of vasovagal syncope occurs in two stages. Initially, several symptoms appear at once, indicating an imminent loss of consciousness:

• sudden pallor of the skin;
• intense cold sweat;
• loss of strength, which is initially observed in the limbs and then spreads to the whole body;
• dizziness;
• noise in ears;
• disorders of the gastrointestinal tract;
• pain appearing in the chest area;
• feeling of rapid heartbeat;
• the occurrence of tunnel vision, in which a person sees only those objects that are located in front;
• increase or decrease in heart rate.

The second stage is characterized by a short-term loss of consciousness. For some people, the symptoms described above do not ultimately lead to fainting.

Causes and triggers of vasovagal syncope

Vasovagal syncope occurs when something triggers the vasovagal reflex, causing the blood vessels to suddenly dilate. The dilation of blood vessels causes a significant portion of the blood volume to accumulate in the legs.

This association is often accompanied by a slowing of the heart rate. As a result, blood pressure suddenly drops. If the drop in pressure is enough to deprive the brain of oxygen, fainting occurs.

In most people with vasovagal syncope, dilation of the blood vessels is the predominant factor causing loss of consciousness. However, in some people, slowing the heart rate plays an important role.

Common triggers for vasovagal syncope include:

• sudden, severe pain;
• blood donation;
• traumatic event;
• extremely difficulty urinating or defecating;
• attack of prolonged and severe cough;
• hyperventilation;
• standing still for a long time (for example, if you sit for a long time);
• overwork in hot weather;
• excessive use of alcohol or substances (such as pills).

If an episode of syncope follows any of these events, vasovagal syncope is almost certainly occurring.

Diagnostic methods

After vasovagal syncope occurs, it is recommended to seek medical help, as sudden loss of consciousness may indicate serious problems in the functioning of the internal systems. In particular, these can be cardiovascular pathologies and malignant neoplasms.

Causes of loss of consciousness with convulsions

Convulsive fainting is one of the most common pathological conditions.

In order to establish the true cause that led to loss of consciousness, the doctor carries out the following measures:

1. Gathering information about the patient’s current condition and main symptoms. In terms of establishing the causes of fainting, it is important to identify the initial phenomena that preceded the loss of consciousness.
2. Analysis of the patient's life. The doctor asks about the patient’s professional responsibilities, concomitant pathologies and medications he is taking.
3. Collection of information about family pathologies. This stage is important, since it has been established that vasovagal syncope in approximately 30% of cases is due to a hereditary predisposition.
4. External examination of the patient, during which the condition of the skin and breathing rate are assessed. Additionally, the doctor listens to the lungs and heart.
5. General analysis .
6. chemistry . It allows you to determine the level of cholesterol, sugar, potassium and other elements.

If the latest tests did not show any abnormalities, then other diagnostic measures are additionally carried out aimed at identifying concomitant pathologies or excluding them.

Electrocardiography

It is prescribed to assess the performance of the heart muscle.

24-hour Holter electrocardiogram monitoring (HMECG)

The procedure lasts from 24 to 72 hours, during which ECG readings are regularly analyzed. Particular attention is paid to the changes that occur in the electrocardiogram during fainting.

Echocardiography

Vasovagal syncope does not affect echocardiography readings. This procedure is performed to exclude cardiac pathologies.

Orthostatic test (title test)

It is this examination method that allows us to detect vasovagal syncope. During the procedure, which lasts no more than half an hour, the patient is placed on a special bed set at an angle of 60 degrees. The patient is connected to a device through which the work of the heart muscle is assessed.

Additionally, blood pressure indicators are measured. After loss of consciousness, there is a sharp decrease in blood pressure and a short-term stop of heart contractions (a pause occurs).

If necessary, an examination by a neurologist is carried out. Electroencephalography and MRI, respectively, can exclude the presence of epilepsy and tumor, which can also provoke loss of consciousness.

Diagnostics

You should consult a doctor immediately after the first attack occurs. Usually the causes of such fainting are not terrible, but sometimes it can indicate serious problems with the functioning of the body. For example, about tumors and cardiovascular diseases that can lead to death.

First, the doctor asks the patient when the fainting began, whether they occur in the same way, what precedes the loss of consciousness, and what the patient can attribute their occurrence to. After this, the doctor begins to be interested in the following questions:

• the patient’s profession and whether it is associated with a risk to life (driver, pilot, diver, roofer);
• whether the patient’s relatives suffer from cardiovascular diseases, whether they have experienced loss of consciousness, since vasovagal fainting can be hereditary.

Then the doctor examines the patient, notes his skin color, appearance of nails, hair, breathing rate, presence of heart murmurs and wheezing in the lungs. Prescribes general and biochemical blood tests.

In addition, diagnostics includes the following procedures:

• Electrocardiography (ECG), which determines the performance of the heart.
• 24-hour Holter electrocardiogram monitoring (HMECG). An electrocardiogram is recorded within 24-72 hours, and if fainting is detected, certain changes are displayed on it. Outside of fainting, normal values ​​are noted.
• Echocardiography (EchoCG). It is carried out only to exclude vascular and heart diseases.
• Orthostatic test. Using this method, a diagnosis of “vasovagal syncope” is made. The essence of this procedure is that the patient lies down on a special bed at an angle of 60 degrees for 30 minutes. During this time, electrocardiogram readings are taken and blood pressure is measured automatically or manually. During fainting, there is a sharp drop in pressure and interruptions in the functioning of the heart.

Vasovagal fainting can also be isolated. They are not necessarily provoked by any disease; loss of consciousness often occurs in completely healthy people.

Therapeutic measures

The treatment regimen for vasovagal syncope is determined based on the severity of the underlying disease. Therapeutic intervention is mainly used for patients who often experience short-term loss of consciousness.

In cases where the problem under consideration arises due to mental pathologies, the treatment regimen is determined depending on the status of the underlying disease.

Therapy for vasovagal syncope consists of several approaches.

Drug treatment

The patient is prescribed the following medications:

Self-medication is dangerous with complications!

Attention

Despite the fact that our articles are based on trusted sources and have been tested by practicing doctors, the same symptoms can be signs of different diseases, and the disease may not proceed according to the textbook.

Pros of seeing a doctor:

• Only a specialist will prescribe suitable medications.

• Recovery will be easier and faster.

• The doctor will monitor the course of the disease and help avoid complications.

find a doctor

Do not try to treat yourself - consult a specialist.

• Alpha adrenergic agonists. They contribute to the narrowing of blood vessels.
• Beta blockers. Such drugs block specific receptors in the body that are activated under the influence of stress hormones (adrenaline and norepinephrine).
• M-anticholinergics. Prescribed for the treatment of bradycardia.

Surgical intervention

Used in the presence of heart diseases and tumors. Surgical intervention, during which, if appropriate indications are available, a pacemaker is introduced, is carried out subject to the following conditions:

• age exceeds 40 years;
• vasovagal syncope occurs with regular frequency;
• absence of initial symptoms indicating imminent loss of consciousness;
• arrest was recorded .

Lifestyle change

You can prevent another loss of consciousness by following these recommendations:

• drink at least two liters of liquid per day;
• exclude heavy physical activity;
• avoid emotional stress;
• sleep at least eight hours a day;
• stop wearing tight underwear, replacing them with compression ones;
• regularly perform exercises aimed at strengthening your mental state.

Special isometric exercises are also used, through which you can increase blood pressure for a short period of time:

• Holding the ball in your hand, you need to squeeze your palm. The action promotes the outflow of venous blood.
• Hands clasp together and then forcefully pull in opposite directions.
• In a standing position, the legs are crossed, after which they must be tensed.

In case of sudden loss of consciousness, the person must be placed on his back with his legs raised above his head. This pose increases blood flow to the brain.

Vasovagal syncope is not dangerous to humans. It causes only two types of complications:

• injuries resulting from a fall;
• deterioration in quality of life in cases where fainting occurs frequently.

Preventive measures can help prevent another loss of consciousness.

Prevention measures

In order to prevent vasovagal fainting, first of all, it is necessary to avoid psycho-emotional stress. In particular, these include both conflict situations that can cause stress and prolonged stay in an upright position. At the same time, active outdoor activities are used as preventive measures to prevent loss of consciousness: walking, running, and so on.

You can also prevent the onset of another fainting spell:

• hardening or contrast shower (strengthens blood vessels);
• adherence to daily routine;
• duration is at least 8 hours;
• Regular consumption of herbal tea, red wine or coffee to restore blood pressure;
• drinking chamomile, lemon balm or St. John's wort tea, which has a positive effect on the nervous system.

Vasovagal syncope is not a dangerous phenomenon, which, however, may indicate serious pathologies: cardiovascular diseases, tumors. You can cope with such phenomena if you change your lifestyle.

Treatment of vasovagal syncope

People who have had a single episode of vasovagal syncope do not need any medical treatment at all.

But if there have been recurring episodes, there will likely be more episodes if the person is not treated. And, as anyone with vasovagal syncope knows, these episodes of fainting often come at the most inconvenient or impractical times and can be very life-disrupting. Fortunately, treatment is usually quite helpful.

There are several main types of treatment for vasovagal syncope: medications, exercise, and a pacemaker.

Medications

In some people, vasovagal syncope occurs with alarming frequency, even when all appropriate precautions are taken. For these people, drug therapy is often helpful.