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Autonomic Neuroscience : Basic &... Dec 2021Vasovagal syncope (VVS) is a very common form of fainting. Treatment begins with patient education about the mechanism of fainting, and the non-lethal nature of... (Review)
Review
Vasovagal syncope (VVS) is a very common form of fainting. Treatment begins with patient education about the mechanism of fainting, and the non-lethal nature of vasovagal syncope. In this article, we review several non-pharmacological approaches that form the foundation of our current treatments. These include increases in dietary salt and water intake, the use of compression garments, physical counter-maneuvers and tilt-training. When these approaches are inadequate, medications can sometimes be effective. While the evidence base for the pharmacological treatment of VVS is modest, recent trial data have found drugs to be useful in placebo-controlled randomized trials. For select patients, and those patients more refractory to medications, procedural treatments may be an option. In this review, we discuss the current state of evidence for the non-pharmacological and pharmacological treatments for VVS, as well as some novel, emerging therapies for VVS.
Topics: Humans; Syncope, Vasovagal; Tilt-Table Test
PubMed: 34763249
DOI: 10.1016/j.autneu.2021.102904 -
Revue Medicale Suisse Apr 2022
Topics: Health Status; Humans; Midodrine; Quality of Life; Syncope, Vasovagal; Treatment Outcome
PubMed: 35481537
DOI: 10.53738/REVMED.2022.18.779.875 -
JAMA Internal Medicine Jun 2021
Topics: Humans; Syncope, Vasovagal
PubMed: 33587099
DOI: 10.1001/jamainternmed.2020.9148 -
International Journal of Cardiology Oct 2022
Topics: Adenosine; Humans; Syncope; Syncope, Vasovagal; Tilt-Table Test
PubMed: 35870636
DOI: 10.1016/j.ijcard.2022.07.036 -
Praxis 2021
Topics: Adolescent; Humans; Midodrine; Probability; Syncope; Syncope, Vasovagal
PubMed: 34875862
DOI: 10.1024/1661-8157/a003766 -
Ugeskrift For Laeger Apr 2024Spinal anaesthesia is considered an effective and safe method for providing pain relief during procedures below the waist. However, in a small subset of patients,...
Spinal anaesthesia is considered an effective and safe method for providing pain relief during procedures below the waist. However, in a small subset of patients, life-threatening vasovagal reactions may develop leading to severe bradycardia and hypotension or ultimately asystole and complete circulatory collapse. Early recognition and prompt treatment of this condition can be lifesaving as illustrated in this case report where the patient developed asystole for ten seconds shortly after placing the spinal anaesthetic.
Topics: Humans; Anesthesia, Spinal; Heart Arrest; Male; Syncope, Vasovagal; Female; Bradycardia
PubMed: 38704723
DOI: 10.61409/V11230702 -
Clinical Autonomic Research : Official... Feb 2023
Topics: Humans; Autonomic Nervous System; Sympathetic Nervous System; Syncope, Vasovagal; Tilt-Table Test; Heart Rate
PubMed: 36538152
DOI: 10.1007/s10286-022-00915-9 -
Autonomic Neuroscience : Basic &... Nov 2020Orthostatic hypotension (OH) is a common clinical manifestation characterized by a significant fall in blood pressure with postural change and is frequently accompanied... (Review)
Review
Orthostatic hypotension (OH) is a common clinical manifestation characterized by a significant fall in blood pressure with postural change and is frequently accompanied by debilitating symptoms of orthostatic intolerance. The reported prevalence of OH ranges between 5 and 10% in middle-aged adults with a burden that increases concomitantly with age; in those over 60 years of age, the prevalence is estimated to be over 20%. Unfortunately, the clinical course of OH is not necessarily benign. OH patients are at an increased risk of adverse clinical outcomes including death, falls, cardiovascular and cerebrovascular events, syncope, and impaired quality of life. The differential diagnosis of OH is broad and includes acute precipitants as well as chronic underlying medical conditions, especially of neurological origin. Appropriate diagnosis relies on a systematic history and physical examination with particular attention to orthostatic vital signs, keeping in mind that ambient conditions during diagnostic testing may affect OH detection due to factors such as diurnal variation.
Topics: Autonomic Nervous System Diseases; Diagnosis, Differential; Humans; Hypotension, Orthostatic; Postural Orthostatic Tachycardia Syndrome; Syncope, Vasovagal
PubMed: 32805514
DOI: 10.1016/j.autneu.2020.102713 -
JACC. Clinical Electrophysiology Feb 2022
Topics: Humans; Syncope, Vasovagal; Tilt-Table Test; Touch
PubMed: 35210070
DOI: 10.1016/j.jacep.2021.11.006 -
Actas Dermo-sifiliograficas Jun 2021This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The... (Review)
Review
This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is fainting due to a vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.
PubMed: 34153522
DOI: 10.1016/j.adengl.2021.06.003