Vasovagal Syncope – Diagnosis and Treatment
Diagnosis
Doctors diagnose vasovagal syncope with a physical exam, symptom review, and medical tests.
A healthcare professional listens to the heart, checks blood pressure, and asks about fainting, dizziness, palpitations, or confusion.
They sometimes check the neck arteries with gentle pressure to see if this causes symptoms like lightheadedness or near-fainting.
Doctors use several tests to rule out different causes. These tests check for problems such as arrhythmias, orthostatic hypotension, cardiac syncope, and structural heart disease.
Common tests include:
- Electrocardiogram (ECG/EKG): Checks for irregular heart rhythms, heart block, or tachycardia
- Echocardiogram: Looks for heart valve problems, issues with heart structure, or cardiomyopathy
- Exercise Stress Test: Monitors blood pressure and heart rhythms during exercise
- Holter Monitor: Worn for 24 hours or longer to catch infrequent arrhythmias
- Blood Tests: Identifies disorders like anemia or metabolic problems
- Tilt Table Test: Assesses how changes in position affect heart rate and blood pressure
Hereโs a summary table:
| Test | What It Checks For | How It Helps |
|---|---|---|
| ECG/EKG | Heart rhythms, arrhythmias | Detects hidden heart problems |
| Echocardiogram | Heart valves, structure | Finds abnormalities |
| Stress Test | Exercise response | Uncovers exercise-induced issues |
| Holter Monitor | Long-term rhythm problems | Captures rare arrhythmias |
| Blood Tests | Anemia, metabolic disorders | Spots treatable causes |
| Tilt Table Test | Blood pressure changes | Diagnoses neurally mediated syncope |
Doctors use these steps to distinguish vasovagal syncope from seizures, metabolic issues, vertebrobasilar insufficiency, and other causes of fainting.
Symptoms like nausea, fatigue, headache, or palpitations before fainting can provide extra clues.
People who faint often or for unknown reasons, especially those with heart disease or who faint during exercise, need a careful review to rule out serious conditions.
Treatment
Most people with vasovagal syncope do not need specific medical treatment.
Healthcare providers help people identify and avoid certain triggers that might cause fainting.
If fainting affects daily life, different methods can help:
- Medications: Doctors may prescribe medicines like fludrocortisone acetate to manage low blood pressure. Sometimes, selective serotonin reuptake inhibitors (SSRIs) are also used to help control fainting episodes.
- Lifestyle Changes: Patients may do simple foot exercises, wear compression stockings, or tense their leg muscles when standing to improve blood flow. Doctors may recommend increasing salt intake if the person does not have high blood pressure. Staying hydrated and avoiding prolonged standing, especially in hot or crowded areas, can help.
- Rare Procedures: In severe cases when other treatments do not work, doctors may place a pacemaker to keep the heartbeat steady.
Note: CPR is usually not needed, as fainting from vasovagal syncope is brief and typically resolves on its own.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Making a list can help your visit go smoothly.
- Write down all your symptoms, such as dizziness or fainting, and note any possible triggers, including physical activity or changes in position.
- List every medicine, vitamin, or supplement you useโthis helps your healthcare team understand your overall health.
- Bring a short list of questions about exercise, possible tests, or treatments.
- If you are seeing a cardiologist, note any past heart problems or family history.
- Use the table below to track key details:
| What to List | Example |
|---|---|
| Symptoms | Lightheaded after exercise |
| Medicines/Supplements | Example: Vitamin D, aspirin |
| Recent changes | Started new blood pressure medicine |
Questions Your Doctor May Ask
A healthcare professional may ask:
What happened right before and during the fainting episode?
Did you feel any symptoms like nausea or blurred vision?
Have you experienced a similar episode before?
Have you changed your medicines recently?
Do you or your family have a history of heart issues or sudden death?
Have you had any head injuries?
Answer honestly and clearly to help your doctor provide the best care.
