Treatment Of Vasovagal Syncope Research Articles

FC13 Diagnosis and treatment of vasovagal syncope — Part II

FC13 Diagnosis and treatment of vasovagal syncope — Part II

FC01 Diagnosis and treatment of vasovagal syncope — Part I

FC01 Diagnosis and treatment of vasovagal syncope — Part I

FC29 Diagnosis and treatment of vasovagal syncope - Part III

FC29 Diagnosis and treatment of vasovagal syncope - Part III

Tilt testing for syncope

Vasovagal syncope is a common cause of sudden collapse. It results from inappropriate activation of left ventricular mechanoreceptors causing sudden vasodilation with bradycardia. Tilt testing is an inexpensive and non-invasive way of establishing a vasovagal diagnosis in unexplained syncope. If critical care nurses improve their understanding of the pathophysiology of vasovagal syncope and the procedure of tilt testing, their care of syncopal patients will be enhanced. This literature review discusses the pathophysiology and clinical presentation of vasovagal syncope. The procedure of tilt testing is explained and the treatment of vasovagal syncope is briefly reviewed.

Role of pacing in the treatment of vasovagal syncope

Patients with frequent vasovagal syncope have a markedly poor quality of life and are often resistant to treatment by standard pharmacologic approaches. Although the evidence is not conclusive, clinical vasovagal syncope is probably associated with some degree of bradycardia. Studies of temporary pacing during tilt-table testing have shown that pacing prevents syncope in more than half of patients who develop a vasovagal response. Three open-label studies of permanent pacing showed that pacing was associated with substantial improvement, and the prospective randomized Vasovagal Pacemaker Study reported an 85% relative risk reduction in patients randomized to pacemaker therapy compared with medical therapy. The roles of specific pacemaker modes in vasovagal syncope have not been determined, although early evidence indicates that rate-drop responsiveness is useful. The second Vasovagal Pacemaker Study may clarify the role of rate-drop responsiveness.

Exercised-Induced Vasovagal Syncope

Syncopal episodes in an athlete brief require a thorough evaluation because some of the possible causes are life-threatening. Two case studies demonstrate the diagnostic work-up, which typically involves electrocardiography, echocardiography, and exercise testing. Tilt-table testing can be used to confirm a diagnosis of vasovagal syncope, but only after structural heart disease has been ruled out. Treatment of vasovagal syncope includes avoiding dehydration and using one or a combination of medications shown to be useful for this condition. Care must be exercised in choosing medications; some are prohibited in organized athletics, and some can hurt performance.

Controversy in Diagnosis and Treatment of Vasovagal Syncope

적으로 나타나며, 일반 검사중에는 증상이 일어나기 어렵고, 증상을 유발시킬수 있는 효과적이고 안전한 진단방법이 없었기 때문에 실신의 원인은 38∼42% 에서는 진단이 되지 않는 것으로 알려져 있다. 실 신은 보통 심혈관성이거나 비심혈관성인 것으로 분류 된다. 여러 원인의 실신중 혈관미주신경성 실신이 가 장 많이 발생하는 것으로 나타나고 있다. 여러 다른 기 전에의해 발생하는 혈관미주신경성 실신은 많은 공통 된 병태 생리적 요소를 공유하는 것으로 나타나고 있 다. 그러나 유발요인들, 구심성, 원심성 신경반사궁, 유 입신호의 중추신경에서의 처리과정에는 많은 차이가 있다. 이와같은 기전으로 인해 혈관미주신경성 실신을 신경전도성 실신(neurally mediated syncope), 심장 신경성 실신(neurocardiogenic syncope), 또는 반복 적으로 발생하여 환자에게 외상을 일으킬수 있으므로 악성 혈관미주신경 증후군(malignant vasovagal synrome)이라고도 부르며, 또 임상형태에따라 서맥이 주 로 동반되는 심장기능 억제성 혈관미주신경 증후군 (cardioinhibitory vasovagal syndrome), 저혈압이 주로 동반되는 혈관미주신경성 증후군(vasoderessive vasovagal syndrome), 및 혼합형 혈관미주신경 증후 군(mixed vasovagal syndrome)으로 구분하기도한 다. 결과적으로 단순한 진단방법, 치료 지침들만 으로는 문제를 규명하고 장기간 증상을 해소하기가 어려워진다.

Cardiac pacing for prevention of recurrent vasovagal syncope.

To review the status of cardiac pacing for the treatment of patients with recurrent vasovagal syncope. A MEDLINE search for English- and French-language articles published between 1980 and 1994 about cardiac pacing for prevention or treatment of vasovagal syncope. The term cardiac pacing was used in conjunction with the terms vasovagal, neurally mediated, or neurocardiogenic syncope, but not with the term carotid sinus hypersensitivity. Case reports and series from peer-reviewed journals were selected if they documented the presence of vasovagal syncope and assessed pacing effectiveness using tilt-table testing, clinical follow-up, or both. Four case reports and four series met these criteria. Findings were summarized individually. Statistical analysis of combined data was inappropriate given differences among studies in patient selection, testing, and follow-up. Pacing may be useful in selected patients with predominantly cardioinhibitory vasovagal responses. Pacing alone may eliminate symptoms in 25% of these patients and may prevent abrupt cardiovascular collapse in others (such as those in whom syncope occurs with minimal or no premonitory sensation). However, interpretation of most available reports has been limited both by the uncertainty associated with using the tilt-table technique to assess pacing effectiveness and by relatively short-term follow-up. The usefulness of cardiac pacing for patients with recurrent vasovagal syncope remains only partly understood. Randomized controlled trials are needed for this and other aspects of the treatment of this condition. Additionally, substantial room remains for innovation both in earlier recognition of imminent vasovagal syncope by implantable devices and in specifically designing cardiac pacing algorithms for treatment of this condition.