Vasovagal Syncope

What is Vasovagal Syncope

Vasovagal syncope, which is also called neurocardiogenic syncope, is a fainting spell in which the blood flow to the brain is reduced because of a sudden drop in heart rate and blood pressure.

Syncope, also called fainting or passing out, is a temporary loss of consciousness. It occurs when the blood flow to the brain is reduced.

Vasovagal syncope often occurs in response to fear or some other type of emotional or physical stress.. This type of fainting spell is generally considered harmless. However, injuries can occur if a child falls during a fainting spell.

What are the causes?

This condition is caused by a sudden decrease in blood pressure and heart rate, usually in response to a trigger. Many factors and situations can trigger an episode. Some common triggers include:

  • Pain.
  • Fear.
  • Seeing blood. This may occur during medical procedures, such as when blood is being drawn from a vein.
  • Common activities, such as coughing, swallowing, stretching, or going to the bathroom.
  • Emotional stress.
  • Being in a confined space.
  • Standing for a long time, especially in a warm environment.
  • Lack of sleep or rest.
  • Not eating for a long time.
  • Not drinking enough liquids.
  • Recent illness.
  • Using drugs that affect blood pressure, such as alcohol, marijuana, cocaine, opiates, or inhalants.

What are the signs or symptoms?

Before the fainting episode, your child may:

  • Feel dizzy or light-headed.
  • Become pale.
  • Sense that he or she is going to faint.
  • Feel like the room is spinning.
  • Only see directly ahead (tunnel vision).
  • Feel nauseous.
  • See spots or slowly lose vision.
  • Hear ringing in the ears.
  • Have a headache.
  • Feel warm and sweaty.
  • Feel a sensation of pins and needles.

During the fainting spell, your child will generally be unconscious for no longer than a couple minutes before waking up and returning to normal. Getting up too quickly before his or her body can recover can cause your child to faint again. Some twitching or jerky movements may occur during the fainting spell.

How is this diagnosed?

Your child’s health care provider will ask about your child’s symptoms, take a medical history, and perform a physical exam. Most times, your child’s health care provider will make a diagnosis based on your explanation of the event plus an electrocardiogram (ECG). Other tests may be done to rule out other causes. These may include:

  • Blood tests.
  • Other tests to check the heart, such as:
    • Echocardiogram.
    • Holter monitor. This is a wearable device that performs a prolonged ECG that monitors your child’s heart over days to weeks.
    • Electrophysiology study. This tests the electrical activity of the heart to find the cause of an abnormal heart rhythm (arrhythmia)
  • A test to check the response of your child’s body to changes in position (tilt table test). This may be done when other causes have been ruled out.

How is this treated?

Most cases of this condition do not require treatment. Your child’s health care provider may recommend ways to help your child to avoid fainting triggers and may provide home strategies to prevent fainting. These may include having your child:

  • Drink additional fluids if he or she is exposed to a possible trigger.
  • Add more salt to his or her diet.
  • Sit or lie down if he or she has warning signs of an oncoming episode.
  • Perform certain exercises.
  • Wear compression stockings.

If your child’s fainting spells continue, he or she may be given medicines to help reduce further episodes of fainting. In some cases, surgery to place a pacemaker is done, but this is rare.

Follow these instructions at home:

Eating and drinking

  • Have your child eat regular meals and avoid skipping meals.
  • Have your child drink enough fluid to keep his or her urine clear or pale yellow.
  • Have your child avoid caffeine.
  • Increase salt in your child’s diet as told by your child’s health care provider.

Lifestyle

  • Have your child avoid hot tubs and saunas.
  • Try to make sure that your child gets enough sleep at night.

General instructions

  • Teach your child to identify the warning signs of vasovagal syncope.
  • Have your child sit or lie down at the first warning sign of a fainting spell. If sitting, your child should put his or her head down between his or her legs. If lying down, your child should swing his or her legs up in the air to increase blood flow to the brain.
  • Tell your child to avoid prolonged standing. If your child has to stand for a long time, he or she should do movements such as:
    • Crossing his or her legs.
    • Flexing and stretching his or her leg muscles.
    • Squatting.
    • Moving his or her legs.
  • Give over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Keep all follow-up visits as told by your child’s health care provider. This is important.

Get help right away if:

  • Your child faints.
  • Your child hits his or her head or is injured after fainting.
  • Your child has chest pain or shortness of breath.
  • Your child has a racing or irregular heartbeat (palpitations).

Summary

  • Syncope, also called fainting or passing out, is a temporary loss of consciousness.
  • This condition is caused by a sudden decrease in blood pressure and heart rate, usually in response to a trigger, such as pain, fear, or illness.
  • Most cases of this condition do not require treatment.
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