Vasovagal Syncope

Diagnosis

Diagnosing vasovagal syncope typically starts with a physical examination. During this exam, your doctor will listen to your heart and measure your blood pressure. They may also gently massage the main arteries in your neck to check if this induces a fainting sensation.

To rule out other potential causes of your fainting, especially heart-related issues, your doctor may suggest several tests, including:

• Electrocardiogram. The electrical impulses your heart generates are recorded throughout this test. It can identify various cardiac issues as well as abnormal heart rhythms. It could be necessary for you to wear a portable monitor for a month or at least for one day.
• Echocardiogram. This test looks for disorders including valve issues, which can lead to fainting, by using ultrasonography to view the heart.
• Exercise stress test. This test examines heart rhythms during exercise and is typically conducted while you walk or jog on a treadmill.
• Blood tests. Your physician may check for diseases like anemia that can either cause or exacerbate episodes of fainting.
• Tilt table test. Your doctor can recommend a tilt table test if there is no indication that your fainting is due to a cardiac condition. You lie flat on your back on a table that tilts you upward at different angles during the test. Throughout the test, a technician keeps an eye on your blood pressure and heart rhythms to see if shifting your posture has an impact on either.

Treatment

In most instances of vasovagal syncope, treatment is unnecessary. Your doctor can help pinpoint your fainting triggers and work with you to develop strategies to mitigate them.

However, if vasovagal syncope occurs frequently enough to disrupt your daily life, your doctor may recommend trying one or more of the following remedies:

• Medications: Fludrocortisone acetate, typically prescribed for low blood pressure, might be beneficial in preventing vasovagal syncope. Selective serotonin reuptake inhibitors could also be considered.
• Therapies: Your doctor might recommend techniques to diminish blood pooling in your legs, like performing foot exercises, donning compression stockings, or tensing your leg muscles while standing. If high blood pressure is not a concern for you, increasing your salt intake may be advised. It’s important to steer clear of prolonged standing, especially in hot, congested spaces, and maintain sufficient fluid intake.
• Surgery: In rare cases, implanting an electrical pacemaker to regulate the heartbeat may be an option for individuals with vasovagal syncope who have not responded to other treatments.