vasovagal syncope

Question 1

definition of vasovagal syncope

Answer 1

Syncope is a syndrome characterised by a relatively sudden, temporary, and self-terminating loss of consciousness, associated with the inability to maintain postural tone, with rapid and spontaneous recovery.

Neurally mediated reflex syncope (NMRS) refers to a group of related conditions or scenarios in which symptomatic hypotension occurs as a result of neural reflex vasodilation and/or bradycardia.[1] Vasovagal syncope (VS) refers to a particular type of NMRS also known as the common faint.

Question 2

aetiology of vasovagal syncope

Answer 2

reflex bradycardia ± peripheral vasodilation provoked by emotion, pain, or standing too long (it cannot occur when lying down), relative dehydration, warm and closed-in environments

transient insufficiency of global cerebral nutrient flow

Question 3

RF for vasovagal syncope

Answer 3

prior syncope

prior history of arrhythmias, MI, heart failure or cardiomyopathy

severe aortic stenosis

Question 4

epidemiology of vasovagal syncop[e

Answer 4

Vasovagal syncope is the single most common cause of syncope. It tends to peak in frequency in young adults and then again in older people.

Question 5

sx of vasovagal syncope

Answer 5

• syncope - onset over seconds (not instantaneous)
• preceded by pre-syncopal symptoms: nausea, pallor, sweating, narrowing of visual fields, deminished hearing, lightheadedness
• brief clonic jerking of limbs may occur due to cerebral hypoperfusion
• urinary incontinence is uncommon
• no tongue biting
• lasts for approx 2mins and recovery is rapid

Question 6

sign of vasovagal syncope

Answer 6

bradycardia

Question 7

Ix for vasovagal syncope

Answer 7

• 12 lead ECG - rules out AV block, bradycardia, asystole, long QT, bundle branch block
• Hb - normal, low in anaemia
• blood glucose
• serum b-HCG
• cardiac enzymes
• d-dimer
• serum cortisol
• urea/serum creatinine