Abstract
Since the classic Lewis’ description of vasovagal syncope (VVS) in 1932, our knowledge on VVS has markedly improved, and we have learned that VVS may have different clinical presentations. The most relevant ones are typical VVS, sleep syncope, atypical VVS, and unexplained fall. Moreover, even sudden death may be a clinical presentation of VVS, when the emotional vasovagal reflex occurs simultaneously with the diving reflex. Typical VVS can be diagnosed after the initial evaluation, when a transient loss of consciousness is triggered by emotional distress or orthostatic stress, in the presence of autonomic prodromes. An atypical VVS can be diagnosed in subjects with transient loss of consciousness not preceded by evident trigger, only when tilt test is positive, in the absence of any competing diagnosis. Many clinical features suggest that sleep syncope is a form of VVS. Very recent data show that an unexplained fall may be a clinical presentation of VVS.
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