Vasovagal syncope refers to a brief loss of consciousness due to neurogenic shock. It usually affects young people. The causes and consequences of this fainting are usually harmless.
What is vasovagal syncope?
Vasovagal syncope refers to a brief loss of consciousness due to neurogenic shock. Vasovagal syncope is a brief loss of consciousness caused by excessive vagal tone. Syncope is the general medical term for a short-lasting loss of consciousness or fainting. Fainting is caused by an insufficient supply of blood to the brain. There are mainly three different causes for this: In addition to the so-called cardiac syncope (cardiovascular disorders) and orthostasis syncope (disorder of blood pressure regulation), reflex syncope plays the most important role. Reflex syncopes are exaggerated circulatory reflexes. They account for the majority of all syncopes. Reflex syncope is subdivided into vasovagal syncope, situational syncope and carotid sinus syncope. The vasovagal syncopes again play the most important role. Young and healthy people (mainly young women) are particularly affected by vasovagal syncope. This is not a disease, but an exaggerated reaction to a very stressful situation. In some cases, a familial predisposition can also be assumed.
Causes
Vasovagal syncope is often triggered by an extreme stressful situation. For example, sudden fear, fright, emotional stress, exuberant joy, or even just standing for a long time can trigger fainting. Sometimes the sight of a few drops of blood is enough. Crowded confinement, alcohol or drugs, of course, promote the tendency to vasovagal syncope. Often, fainting occurs with sudden onset of pain following an injury. By some physicians, vasovagal syncope is considered a relaxation reaction of the body. The excessive reaction of the vagus nerve is responsible for this form of syncope. The vagus nerve is the so-called roving nerve of the body and is responsible for the activity of the internal organs. Among other things, it ensures that the body can react quickly in dangerous situations. In danger, for example, muscles need to be supplied with more blood in order to be able to flee more quickly. This results in vasodilation of the blood vessels (enlargement of blood vessels) and thus a stronger blood supply to the affected regions of the body. At the same time, the brain is briefly undersupplied. The pulse also drops for a short time. The parasympathetic nervous system enters an extreme state of excitation, with an excess of acetylcholinesterase inhibitors that prevent acetylcholine from being broken down. The individual briefly faints.
Diseases with this symptom
- Cardiovascular disease
- Orthostatic dysregulation
- Diabetes mellitus
Diagnosis and course
Vasovagal syncope is manifested by sudden falling over or slumping. In this case, the brief unconsciousness ends immediately when the patient is in a horizontal position because of improved return flow to the heart. There is also short-term confusion. The approach of fainting can be foreshadowed by certain signs shortly beforehand. Early symptoms often include pallor, dizziness, and nausea. To wake up from unconsciousness, the horizontal position of the patient is necessary in any case. In the upright position, blood return to the heart is disturbed, so there is danger in this case. Syncope lasts only a short time. Afterwards, the circulation stabilizes again. If the unconsciousness does not cause any injuries from falling over, no consequential damage occurs in vasovagal syncope. It must always be emphasized that this is not a disease, but an extraordinary psychological situation. When syncope occurs, its cause should be diagnostically clarified. Although vasovagal syncope is harmless, a serious cause may of course be hidden behind the fainting spell. Thus, cardiac syncope and orthostasis syncope must be excluded as differential diagnoses. This also applies to other seizure-like disorders of consciousness such as epileptic seizures, strokes or hypoglycemia.First, a general medical history is taken, which includes questions about previous illnesses, family history and symptoms. Furthermore, blood pressure is measured while the patient is lying down and standing up. If comprehensive diagnostics do not lead to a determination of the cause of the syncope, a tilt table examination can also be performed. In this case, the patient is slowly tilted up from the horizontal position to 60 to 70 degrees with the examination table. This always causes blood to pool in the lower extremities. The result is a reduced supply of blood to the heart and a reduction in heart rate. Although fainting is provoked, it is intentional. The purpose of this test is to check whether there is a normal circulatory response. If this is the case, vasovagal syncope can be assumed.
Complications
It is extremely rare for life-threatening complications to occur with neurocardiogenic or vasovagal syncope. Unlike most fainting disorders, this syncope, which occurs in young people, is more likely to occur in cases of emotional overload or shock. The only complications to avoid here are injuries resulting from the fall. However, to definitively rule out other causes, it is advisable to see a doctor. This can, especially if the brief fainting occurs more frequently in the teenager, examine the affected person for a circulatory weakness, eating disorders or a heart defect. After all, even if at first it appears to be simple reflex syncope at a certain stage of life, younger patients may also have orthostatic or cardiac syncope that requires urgent treatment. Furthermore, when taking a history of syncope, the physician should pay attention to the patient’s previous illnesses: For example, if the adolescent is also diabetic, he or she is most likely dealing with insulin maldosing. To clearly classify regularly occurring, supposedly vasovagal syncope, affected individuals should undergo an orthostasis test, an ECG, and an EEG by the treating physician.
When should one go to the doctor?
In most cases, this condition is a harmless symptom that usually does not require further treatment by a physician. As a rule, the affected person himself can also not see a doctor at all if he loses consciousness. However, relatives or parents should call a doctor if unconsciousness occurs. Furthermore, the patient must be prevented from falling so that no further injuries or bumps occur. Most often, confusion or dizziness occurs before unconsciousness. However, unconsciousness cannot be anticipated. Treatment is needed if the complaint occurs more often or if it is an epileptic seizure or stroke, for example. In these cases, urgent treatment by a physician is necessary. In any case, unconsciousness must be followed by an examination by a physician so that the trigger or the underlying disease can be diagnosed. Epileptic seizures must also be treated by a doctor in any case.
Treatment and therapy
Treatment of acute syncope, regardless of its cause, consists of lowering the upper body and elevating the legs. This allows blood to flow back to the heart. In the case of vasovagal syncope, further treatment is usually no longer necessary. However, if an injury such as a concussion has occurred as a result of the fall, it must of course be treated immediately by an emergency physician.
Outlook and prognosis
In vasovagal syncope, there are usually no particular complications or symptoms. In most cases, the condition is harmless and does not present a condition that is harmful to the body. The short-term unconsciousness occurs very suddenly in most cases. The affected person suffers from confusion and concentration disorders. Often, dizziness and nausea also occur before unconsciousness, and the patient is pale. Usually the state of unconsciousness does not last long and the circulation stabilizes again. There is no further discomfort if the patient has not sustained any injury as a result of falling over. If the fainting episodes occur more often, a doctor should be consulted. In this case, the symptom may hide another underlying disease that needs to be treated.In serious cases, these are diseases of the heart, which must be treated in any case. The symptom can also occur in diabetics and is usually due to incorrect dosage of insulin. If unconsciousness occurs after an accident or after a concussion, an emergency doctor must be consulted so that no consequential damage occurs. In most cases, however, a positive course of illness occurs.
Prevention
In case of a frequent occurrence of vasovagal syncope, the patient can learn to pay attention to the early symptoms and prevent or at least delay fainting by performing certain exercises. Such isometric exercises as interlocking the hands or crossing the legs are suitable for this purpose. If necessary, the patient should immediately sit down on the floor in an imminent situation. In general, vasovagal syncope can be prevented by the use of alternating showers, adequate hydration, and regular exercise.
Here’s what you can do yourself
Realizing that vasovagal syncope is unpleasant but not dangerous already goes a long way toward improving quality of life in many cases. In everyday life, situations that could trigger fainting should be avoided whenever possible. These include being in stuffy rooms, large crowds, standing for long periods of time, and being overworked by stress without adequate recovery periods. Alcohol increases the tendency to vasovagal syncope and should therefore only be consumed in small amounts. It is also important to pay good attention to warning signals from the body. If an approaching fainting spell is noticeable by dizziness, cold sweat and lightheadedness, it is often helpful to quickly sit down, lie down or get some fresh air to normalize the circulatory situation. So-called counterpressure exercises, which can be performed to prevent vasovagal syncope, also cause an increase in blood pressure. This involves crossing the legs while standing and tensing the abdominal, buttock and leg muscles. In a second exercise, the fingers of both hands are interlocked at chest level, and the arms pull outward forcefully on both sides. Squeezing a ball or other soft object with the hand can also avert impending fainting. Alternating showers and regular exercise are suitable for strengthening the circulation in general, and attention should also be paid to adequate fluid intake.