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Syncope, Reflex (Vasovagal Syncope)

Melinda Kwan, DO, MPH and Norton Winer, MD Reviewed 06/2022
 


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

  • History of syncope during or immediately after exertion is concerning for cardiac syncope.

  • Neurally mediated syncope is preceded by blurred vision, palpitations, nausea, warmth, diapho...

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
Zou R, Wang S, Lin P, et al. The clinical characteristics of situational syncope in children and adults undergoing head-up tilt testing. Am J Emerg Med. 2020 Jul;38(7):1419-1423.
2
Rocha BML...

ADDITIONAL READING

Romano S, Branz L, Fondrieschi L, et al. Does A Therapy for Reflex Vasovagal Syncope Really Exist? High Blood Press Cardiovasc Prev. 2019 Aug;26(4):273-281. ...

SEE ALSO

Algorithms: Syncope; Transient Ischemic Attack and Transient Neurologic Defects 

CODES

ICD10

R55 Syncope and collapse 

SNOMED

  • 398665005 Vasovagal syncope (disorder)

  • 398652001 Vasovagal attack (disorder)

  • 248229009 Vasovagal symptom (finding)

  • 234163005 Neurally-mediated syncope

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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