Vasovagal Response - Treatment

Treatment

Treatment for vasovagal syncope focuses on avoidance of triggers, restoring blood flow to the brain during an impending episode, and measures that interrupt or prevent the pathophysiologic mechanism described above.

• The cornerstone of treatment is avoidance of triggers known to cause syncope in that person. However, a new development in psychological research has shown that patients show great reductions in vasovagal syncope through exposure-based exercises with therapists if the trigger is mental or emotional, e.g. sight of blood. However, if the trigger is a specific drug, then avoidance is the only treatment.
• Because vasovagal syncope causes a decrease in blood pressure, relaxing the entire body as a mode of avoidance isn't favorable. A patient can move or cross his/her legs and tighten leg muscles to keep blood pressure from dropping so drastically before an injection.
• Before known triggering events, the patient may increase consumption of salt and fluids to increase blood volume. Sports and energy drinks may be particularly helpful.
• Discontinuation of medications known to lower blood pressure may be helpful, but stopping antihypertensive drugs can also be dangerous in some people. Taking antihypertensive drugs may worsen the syncope, as the hypertension may have been the body's way to compensate for the low blood pressure.
• Patients should be educated on how to respond to further episodes of syncope, especially if they experience prodromal warning signs: they should lie down and raise their legs, or at least lower their head to increase blood flow to the brain. If the individual has lost consciousness, he or she should be laid down with his or her head turned to the side. Tight clothing should be loosened. If the inciting factor is known, it should be removed if possible (for instance, the cause of pain).
• Wearing graded compression stockings may be helpful.
• There are certain orthostatic training exercises which have been proven to improve symptoms in people with recurrent vasovagal syncope. A technique called "Applied Tension" which involves learning to tense the muscles in the torso, arms, and legs is effective for vasovagal syncope.
• Certain medications may also be helpful:
  • Beta blockers (β-adrenergic antagonists) were once the most common medication given; however, they have been shown to be ineffective in a variety of studies and are thus no longer prescribed. In addition, they may cause the syncope by lowering the blood pressure and heart rate.
  • Other medications which may be effective include: CNS stimulants fludrocortisone, midodrine, SSRIs such as paroxetine or sertraline, disopyramide, and, in health-care settings where a syncope is anticipated, atropine epinephrine (adrenaline).
• For people with the cardioinhibitory form of vasovagal syncope, implantation of a permanent pacemaker may be beneficial or even curative.
• Types of Long-Term Therapy for Vasovagal Syncope include:
  • Preload agents
  • Vasoconstrictors
  • Anticholinergic agents
  • Negative cardiac inotropes
  • Central agents
  • Mechanical device