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Q J Med 1999; 92: 697-705
© 1999 Association of Physicians

Reviews

The management of vasovagal syncope

S.W. Parry and R.A. Kenny

From the Cardiovascular Investigation Unit, Department of Geriatric Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK

Dr S.W. Parry, Cardiovascular Investigation Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP. e-mail: S.W. Parry@ncl.ac.uk


   Introduction
 
Syncope, defined as transient loss of consciousness with loss of postural tone but with spontaneous recovery,1 accounts for 3% of Accident and Emergency attendances2 and 1% to 6% of hospital admissions annually,3 and has a prevalence of up to 23% in the institutionalized elderly.4 In last month's review,5 we described the head-up tilt-table test and its use in the diagnosis of the vasovagal syndrome, the commonest cause of syncope. This article aims to provide an overview of the management of the vasovagal syndrome, on the basis of current evidence and our experience in this field. Throughout the article, the terms `vasovagal syncope' and `vasovagal syndrome' will be used interchangeably.


   Symptoms of the vasovagal syndrome
 
Syncope is the most common presenting symptom of the vasovagal syndrome, though patients may present with pre-syncope and dizziness without loss of consciousness. A prodromal syndrome of variable duration is common, with light-headedness, weakness, a sensation of air-hunger or hyperventilation, detachment . . . [Full Text of this Article]


   Diagnosis of vasovagal syncope
 

   Treatment of vasovagal syncope
 
Methodological problems in the evaluation of therapies for vasovagal syncope
Head-up tilt-table test reproducibility
Placebo effect and efficacy of diagnosis in reducing rate of syncope recurrence
Amelioration of vasovagal syncope with time
Conservative advice and withdrawal of culprit medications
Pharmacological treatment of vasovagal syncope
Beta blockers
Disopyramide and other anti-cholinergics
Midodrine and other {alpha}-adrenergic agonists
Fludrocortisone
Theophylline
Selective serotonin reuptake inhibitors (SSRIs)
Enalapril
Permanent pacemaker therapy for vasovagal syncope
Miscellaneous

   Management of vasovagal syncope: recommendations
 

   References
 

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