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Syncope, Reflex (Vasovagal Syncope)

Melinda Y. Kwan, DO, MPH and Norton Winer, MD Reviewed 06/2019
 


BASICS

A reversible loss of consciousness and postural tone secondary to systemic hypotension and cerebral hypoperfusion due to vasodilation and/or bradycardia (rarely, tachycardia) with spontaneous r...

DIAGNOSIS

HISTORY

  • Rule out cardiac syncope.

  • Neurally mediated syncope is preceded by blurred vision, palpitations, nausea, warmth, diaphoresis, or light-headedness, or there may be history of nausea, wa...

TREATMENT

Therapy is primarily for recurrent syncope. Situational syncope does not warrant specific treatment. 

GENERAL MEASURES

Identify and avoid precipitating events or situations 

MEDICATION

First Line

ONGOING CARE

DIET

  • Increased salt intake may help if not otherwise contraindicated (2)[C].

  • Maintain fluid intake.

PATIENT EDUCATION

  • Identify and avoid precipitating events or situations.

  • Avoid dehydration, ...

REFERENCES

1
Angaran P, Klein GJ, Yee R, et al. Syncope. Neurol Clin.  2011;29(4):903–925. [View Abstract on OvidMedline]
2
Raj SR, Coffin ST. Medical therapy and physical maneuvers in the treatment...

ADDITIONAL READING

  • Lelonek M. Genetics in neurocardiogenic syncope. Przegl Lek.  2006;63(12):1310–1312. [View Abstract on OvidMedline]

  • Márquez MF, Urias-Medina K, Gómez-Flores J, et al. Comparison...

CODES

ICD10

R55 Syncope and collapse 

ICD9

780.2 Syncope and collapse 

SNOMED

  • 398665005 Vasovagal syncope (disorder)

  • 398652001 Vasovagal attack (disorder)

  • 248229009 Vasovagal symptom (finding)

  • 234163005 Neura...

CLINICAL PEARLS

  • A careful history of the events preceding the syncopal episode helps guide evaluation and management.

  • Rule out cardiac or neurogenic syncope.

  • Prodrome is common with reflex syncope.

  • Recov...

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