HEALTH TALK: Vasovagal Syncope

INTRODUCTION

Vasovagal syncope is the most common cause of FAINTING, and happens when your body reacts in an exaggerated way to such triggers as getting your blood drawn or extreme emotional distress. This causes a sudden drop in your heart rate and blood pressure, reducing blood flow to your brain, and causing you to briefly lose consciousness.

Vasovagal syncope is usually harmless and requires no treatment. But certain tests may be recommended to rule out more serious causes of fainting, such as heart disorders.

SYMPTOMS

Before you actually faint from vasovagal syncope, you may experience some of the following:

Lightheadedness
Nausea
Feeling of warmth
A cold, clammy sweat
Pale appearance to your skin, if you’re white or light-skinned.

Fainting can be a sign of a more serious condition, such as a heart or brain disorder, so you may want to see the doc after a fainting spell, especially if it’s not the first time.

CAUSES

Vasovagal syncope occurs when the part of your nervous system that regulates heart rate and blood pressure malfunctions in response to a trigger. Your heart rate slows, and the blood vessels in your legs widen. Blood then pools in your legs, lowering your blood pressure. The blood pressure drop and slowed heart rate quickly result in diminished blood flow to your brain, and you faint.

Some triggers of vasovagal syncope include:
Standing for long periods
Heat exposure
Fear of bodily injury
The sight of blood
Having blood drawn
Exertion, such as straining on the toilet

PREPARE FOR YOUR APPOINTMENT

Sometimes, appointments can be brief, so it’s always wise to be prepared to make the best use of the time allotted.

You can:

Write down a detailed description of your symptoms, including any triggers that may have been involved in you fainting.
Make a list of all your medications, even vitamins and supplements.
Write down questions to ask the doc, including the type of test you might need, and about treatments that might be helpful.

Doctor might be expected to ask you questions, such as:

What were you doing just before you fainted? What’s the last thing you remember before, say, somebody was helping you up?
What signs and symptoms, if any, did you get before you fainted?
Have you ever fainted before?
Have you recently started taking a new medication?
Have you ever had a head injury?
Has anyone in your family died suddenly from heart problems?

During the examination, doc will listen to your heart and, of course, take your blood pressure. You may also get a massage of the main arteries in your neck; that may actually cause you to feel faint.

DIAGNOSIS AND TESTS

Diagnosis of this problem is usually a matter of ruling out other potential causes of your fainting, especially heart-related problems.

Tests may include:

Electrocardiogram (ECG, EKG). Many of you will at least have heard about this or might even have had it. I’ll save a little space in that case.

Echocardiogram. This uses special ultrasound to get a heart image, to look for conditions such as valve problems that can cause fainting.

Blood tests. Anemia can cause fainting spells, so doc will want to check your hemoglobin, among other things.

If there seems to be no heart problems causing your fainting, doc may suggest you undergo a tilt table test. First, you lie flat on a table. The table then changes position, tilting you upwards at various angles, to see if these changes in posture affect your heart rhythms or blood pressure.

TREATMENTS AND DRUGS

Treatment is unnecessary in most vasovagal syncope cases. Doc may help you identify fainting triggers and discuss ways you can avoid them. However, if you get it often enough to interfere with your social and/or occupational functioning, one or more of the following remedies may be suggested.

Blood pressure drugs. A class of drugs called beta-blockers, such as metoprolol, are used to treat high blood pressure. But they are also the type used most often to prevent vasovagal syncope, as they block some of the signals that can lead to fainting.

Antidepressants. Selective serotonin reuptake inhibitors (SSRI’s) such as Paroxetine (Paxil), Fluoxetine (Prozac), and Sertraline (Zoloft) have been successful in preventing vasovagal syncope.

Blood vessel constrictors. Drugs to treat low blood pressure or asthma sometimes have been found helpful in preventing syncope.

OTHER THERAPIES

To prevent pooling of blood in the legs, foot exercises, wearing elastic stockings or tensing your leg muscles when standing may also assist in preventing a fainting spell. Avoid prolonged standing – especially in hot, crowded places, and make sure you drink plenty of fluids.

SURGERY

Always a last resort, vasovagal syncope can be helped by the insertion of an electrical pacemaker, which helps regulate the heart beat.

See you next week.