Vasovagal Syncope

Biology 202
2003 Second Web Paper
On Serendip

Vasovagal Syncope

Laurel Jackson

My best friend "Dirk" can easily be picked out of a crowd. His 6'7 stature, impressive muscle mass, very blond hair, big blue eyes, and booming voice cause many people to stare at him-once, in Europe, a Japanese couple asked if they could take a picture of him. Addicted to weight lifting and athletics, my friend does not always enjoy admitting that he is a computer engineer-yes, my 22-year-old buddy is still afraid of the geek label. There is something else to which Dirk will not readily admit-he faints at the sight of blood. In fact, many things can trigger his fainting spells: blood, vomit, overheating, etc.

Dirk lives next door to my parents; we grew up together. Recently, he and my sister ran over from his house to ours, which is a distance of about 50 feet. My sister had not worn shoes; when they got to our house, they walked through two rooms before Dirk got dizzy. My sister had cut her foot, and the blood that had spread over the tile floor made Dirk turn his head away, and sit down. My mother ran to the rescue-Dirk's, not my sister's. She helped him breath deeply, and luckily he avoided fainting.

A few Christmases ago, Dirk caught a stomach virus. He made it to the bathroom just in time, but seconds after vomiting, he fell to the floor, and blocked the door. His parents frantically tried to open the door, they tried to revive him by screaming for probably five minutes, which seemed like an eternity to them at the time. Eventually they revived him.

The summer before that Christmas, Dirk was golfing with his high school's golf team on a hot July afternoon. At the end of the course, he and his coach walked to the parking lot. All of a sudden, Dirk toppled like a tree onto the pavement, suffering a concussion on top of fainting. Dirk's condition is called vasovagal syncope. Stubborn as he is, he often gets angry with his mother, a nurse, for fussing over him. But his mother knows from 22 years of experience that whether it is a particularly hot and humid day, or it is receiving a vaccination, Dirk will pass out unless he takes the proper precautions-resting, breathing deeply, and staying hydrated.

Vasovagal Syncope, also known as fainting, neurocardiogenic syncope, and neurally mediated syncope, is a very common condition, occurring in roughly half of all people at least once within their life; three percent of the population develops it repeatedly. It is not a serious condition.(2) A vasovagal response involves a decrease in the volume of blood that is returned to the heart, which enervates the baroreceptors(2) in the sympathetic nervous system to increase the force of each contraction of the heart. Consequently, the opposing parasympathetic nervous system is alerted to slow the heart rate and dilate the surrounding veins and arteries. These responses of the nervous system cause the blood pressure to drop very low, causing syncope (loss of consciousness).(1) Most patients are young and healthy, although vasovagal syncope can occur in the elderly population that has preexisting cardiac problems. Extremely hot weather and blood-alcohol levels are typical triggers. Some patients suffer from several, often attacks, while others may only experience them sporadically.(3)

While standing, the blood tends to settle in the legs. Maintaining the position for a long time can decrease blood pressure, which means that the brain may not receive proper blood supply. Lack of sufficient oxygen and nutrients can lead to syncope. In general, people do not pass out from standing upright. Mechanisms within the body control blood pressure. In a condition such as vasovagal syncope, the mechanisms do not perform their functions in the appropriate manner, misfiring, over-firing, or under-firing. Faulty mechanisms in the nervous system make syncope a possibility.(3) The mechanisms occur in everyone as we adjust to a new posture. Those with vasovagal syncope have an abnormal reflex to this information-there is an inundation of the messages from the barorecptors, and this overcompensation causes the halting of messages sent from the brain to constrict vessels, and the reverse is communicated, vessels dilate, less blood reaches the brain, and fainting ensues.(2)

In general, physicians use the tilt table test to determine if a diagnosis is necessary. The patient is placed in a quiet room, on either a hydraulic lift of swinging bed that can rotate between 60º and 90º, moving the patient from supine to head-up position. Heart rate and blood pressure are monitored throughout the test. Although some variation in technique exists within practicing physicians, the patient is usually monitored in the supine position for five minutes, and baseline heart rate and blood pressure measurements are taken. Next, the patient is moved into the head-up tilt position, and changes in blood pressure and heart rate, and the appearance of symptoms are noted every three to five minutes. If the patient experiences syncope, the patient is returned to the supine position, and they are considered diagnosable. If no symptoms of vasovagal syncope are recorded after at least ten minutes, often the tilt test is attempted again, this time giving the patient isoproterenol, which often shortens the amount of time before syncope occurs. When isoproterenol is used, physicians usually require a loss of consciousness in the patient in order to support a diagnosis of vasovagal syncope.(4)

Medicinal treatments include beta-blockers, fludrocortisone, midodrine, and SSRIs (selective seratonin reuptake inhibitors). Beta-blockers block the adrenaline system, preventing the abnormal reflex of the sympathetic nervous system that precedes the decrease of blood pressure. Fludrocortisone sends a message to the kidneys to retain more salt and water, thus increasing blood pressure. Midodrine tightens blood vessels. SSRIs are usually used in the treatment of depression or anxiety, but they also block the communication in the brain that triggers the blood vessels to open further.(2)

Instead of subjecting themselves to medications, patients with vasovagal syncope tend to choose lifestyle changes, and in most cases, this is all that is necessary for controlling the condition. Both recognizing their personal triggers, and learning to recognize when an episode is about to occur are necessary; an increase in the amounts of water and salt intake can prevent attacks. Blood is primarily composed of water and salt, so by increasing the amount of each, blood pressure may rise, possibly preventing syncope. More of both are needed especially in hot weather, or when vigorous exercise is performed.(2)

Patients who seek treatment outside of modern medicine often turn to licorice root, also known as sweet root. One of the active ingredients is glycyrrhizic acid. It has been used worldwide for thousands of years to treat a variety of ailments. Recent studies have shown that is useful in the treatment of heart disease. When consumed in large quantities, licorice root can raise the level of aldosterone found in the blood. Although this would be considered negative in most individuals, the increase of aldosterone can increase blood pressure, which is helpful in those with vasovagal syncope. If blood pressure increases around the time of a vasovagal episode, the constriction might counteract the activity of the parasympathetic nervous system, reducing the chance of syncope.(5)

Although vasovagal syncope is not a serious medical condition, those who suffer from its effects, like Dirk, cannot write off its impact on their lives. Tough guy to the core, he believes that taking beta-blockers or any other medication would be admitting that he is incapable of controlling himself. As I researched vasovagal syncope for this paper, I tried to explain the physiological processes that occurred in the body that had nothing to do with personal choice, and all though he was interested, he still maintains that he can control the episodes. I hope that this paper proves to everyone else who does not have a hard head that vasovagal syncope is not a matter of choice, apart from the choice of exposure incidents. I have asserted throughout this paper that vasovagal syncope is not a serious condition; it does, however, provide an interesting platform for research. I assumed, when I began researching, that I would find evidence of scientific research apart from merely understanding the process of syncope. Much of the knowledge seems to have been gleaned from observation of drug effects, so there has been no treatment specifically designed to treat vasovagal syncope. Perhaps more research will lead to more conclusive knowledge about the condition.

References

1)Med Help International, This website offers a forum for those with medical questions, allowing them to ask the advice of a physician.

2)London Cardiac Institute, This organization provides information to patients on several conditions. The patients are referred to the pages by their physicians.

3)Karen Yontz Women's Cardiac Awareness Center, Health Wise Physician's Corner provides information about several medical conditions.

4)Tilt Table Test

5)Health and Age

 

 

Continuing conversation (to contribute your own observations/thoughts, post a comment below) 10/01/2005, from a Reader on the Web Laurel Jackson's article about her friend Dirk's vasovagal syncope was helpful to me, as I have had about 10 such episodes in my life, maybe more, and mostly due to intense abdominal pain. The last 3 episodes (in 3 years) have included seizure-like symptoms, and even if I lay down on the floor when I feel a faint coming on, I still go out. I'm looking for more info about the abdominal pain trigger. thanks Linda Khandro 11/19/2005, from a Reader on the Web To Laurel Jackson author of Vasovagal Syncope: The article you wrote was very helpful. My situation is very similar to Dirk's but yet a little different. I recently had an episode of Vasovagal Syncope and then spoke to my doctor about it a few days later. It was the first time anyone had ever give me a name for the condition. Although I had been having episodes of Vasovagal Syncope from the age of 12-48, I hadn't had one in 14 years. I thought maybe I had outgrown it. Unlike the article you wrote, of the approximate 15 times I've passed out, in all but 1, I threw up immediately following passing out. And threw up and threw up, etc. In several cases, I passed out again several more times in the next few hours and continued to throw up. Three or 4 of the last 4 times, I've ended up going to the emergency room because I was so nauseated and couldn't eat or drink anything without throwing up. In the emergency room, they gave me IVs to replenish my fluids. Within a few hours I felt great and had no further symptoms. It seemed as if passing out way the way my body forced me to throw up. So, if I threw up it seemed like I wouldn't pass out. This last time it caught me by surprise. I felt like I had to throw up that morning when I got up, but I passed out before I had the chance to throw up. My concern is how to live with Vasovagal syncope without ending up in the emergency room with each episode. I naturally have fairly low blood pressure. It normally averages around 105 over 65. It seems like my body can't increase my blood pressure level naturally. You also mentioned that dehydration can cause it, but how can you rehydrate when you keep throwing up. If you anyone has any suggestions I would welcome them. Nancy Beckman 11/29/2005, from a Reader on the Web I haved searched high and low for answers to this condition.I have had 3 episodes this year once having to get stitches put in my head from banging into a coffee table.All these episodes of blacking out were all accompaniedby intense abdominal pain.It is an embarrassing condition.The last time I blacked out it took about 15 minutes to be revived,not to mention I had just started a new job and was working that day.All of these episodes had me hospitalized with no answers.Ihave also seen a neurologist and had tests done and nothing was determined.I just dont want to live my life this way not knowing when it will happen again.If anybody has this condition I would really like some support from others dealing with this. 01/01/2006, from a Reader on the Web I just read an article by a student concerning Dick and his vasovagal syncope episodes. What I wanted to express is that although this condition is not life threatening it still can be potentially a dangerous situation. My mother was a nurse and firmly did not believe in pampering me, so when I was growing up and sometimes fainted she would just tell me to drink more water from now on. I never did find out why I would faint as often as I did until my early 50's when my aunt, who is also a nurse explained to me this condition. By that time I had several small scars on my face, numerous broken glasses, and a chipped front tooth- all the results of my falling when I faint. If I am lucky, I will faint on a carpet floor, but more likely I end up fainting on the bathroom floor and hitting my head on the bathtub or tile floor. It may sound like I faint all the time, but not really, usually averages once every yr. But if I had only known what it is and why it happens, I could have prevented my fainting long ago. Armed with this new information, I will be much more diligent to drink my water, watch out for the symptoms, and not stand for long periods of time. Thank you so much for articles like these. Gayland Leann Cotton 01/15/2006, from a Reader on the Web Hi. I found this website randomly in a search for "vasovagal syncope" and after reading the article that was written about Dirk a big strong man with fainting episodes, I can totally sympathize with him. I am a 26 year old female who has been experiencing the same symptoms on and off since I was very young- which I have been calling "passing out"-but now that I've been an ER nurse for almost three years, I can tell you that I would not just accept such a condition as normal without completely researching it myself. Crazy thing is, I recently had such an episode a few hours ago after two years of not having had any syncopal episodes. The last fainting episodes I have experienced over the years were brought on by a classmate lanceting my fingertip during a bio lab where the room was extremely warm, direct trauma to my body where I banged my knee or elbow really hard against something sharp, severe abdominal cramps during menstruation, and most recently today it was triggered by going from hot to cold to hot environments and not having had any breakfast or fluids since the night before. I know that this is something that I can control now- but I want to educate people who feel this is abnormal that you are not alone. When I experienced it the first few times and my family or friends were around it was pretty scary for them. I would feel very dizzy and then lose consciousness and either drop to a chair and fall from it or if i was on the floor my eyes would roll back and I would fall and start twitching slightly as I have been told by witnesses. For the first 30seconds to one minute I wouldn't be able to hear anything going on around me...but then I start to come out of the blackout very slowly but hear loud buzzing in my ears and feel this paresthesia...pins and needles sensation all over my body...like I am there but not really there. After coming completely out of it five minutes later I would get up feeling very weak and tired...nauseous and vomiting..sometimes developing a headache which takes time to get over...a few hours to the whole day. I just wanted to share my experience and also give you these few tips- If you feel like you are experiencing the warning signals of an impending vasovagal syncopal episode--dizziness or feeling lightheaded,buzzing sensation in your ears,nausea,vomiting,visual disturbances after some emotional or physical stressor is introduced--- 1.DROP to the FLOOR...dont try to sit in a chair because you will fall off and end up injuring yourself. 2.PUT your HEAD between your KNEES if you are sitting on the floor and breathe slowly and deeply to try to prevent the episode. 3.If you can lay in a flat position you can let the blood go from your legs to your upper body and head--this will raise your blood pressure and prevent the syncopal episode from occurring most times. 4. Preventive Measures-Make sure you drink plenty of fluids like water,gatorade before going out to work or school in the morning. That does not include tea or coffee which dehydrate you and drop your blood pressure further!! Things with salt and water will increase your blood pressure. Try not to stand for long time periods-standing up in church for hours without sitting down, moderate to extreme exercise routines and not have any food or drink in your system periodically. 5.Get to an ER or your private doctor or neurologist if you do not feel well or can't recuperate after such an episode and make sure they rule out any cardiac related syncope which is a much worse situation than vasovagal syncope. 6. EKG,Head CT, MRI of the HEAD should all be normal if you have vasovagal syncope such as I did. Table tilt testing is another option I haven't tried but this is used for medically inducing the syncopal episode in the presence of healthcare professionals. Thanks for reading and stay healthy! Seema

 

 

Hi, after reading this I had to talk about my husband Tim who is 39 and has been having episodes for awhile noe. The worst part is my husband is a type a personality and the first time he had one we were fishing and he almost drowned because he fell overboard. We didnt realize what it was at the time but the nezt episode happened on a fight. He felt dizzy abd sick to his stomache and thought eh was going to passout. I was not with him during this flight and did not make any connection to the boat incident, until a couple of years later our fqamily was on a flight heading to a huge family cruise in San Juan- only 1 hour into the flight he panicked and passed out...more like seizures. It happened three times before they finally landed. And after tests done at home after returing, they diagnosed him with this vasovagus syncopy. Now two years after the cruise incident, he upon awakening is going down the stairs in the morning on the way to work and trips down the stairs....being in so much pain from the fall he tells my ten yr old to get me. Upom findng him he is laying in the kitchen completely unconsious yet with eyes open and talking incoherently. call 911 and his diagnosis is that the cat scan was okay...it must have been the fall that triggered the vasavagal syncopy....??? The worst part was my husband had no memory of the past two weeks immediatly after the incident. He could not tell me what day it was or that he had travelled to Arizona (and had an attack of kidney stones..which is quite memorable in my book) He was confused and kept asking the same questions. I understand the vasovagel nerve issue but why the confusion. His cat scan was normal so I am hoping it was just somehow related to the incident and his memory is returning...but being a self employed, type a peronality...I worry...alot. Just venting a little, since this happended today. Have to admit (between us) I thought the worst and thanked god for the outcome ... Laurel D, 19 September 2006

 

About four weeks ago now my husband had been real sick, then was out all day the next day in the heat and sun. He wasn't eating well or drinking and by the end of the day was absolutely worn out. (Looking for car parts with family)

When he got home, we talked for about 20 minutes then he went to shower. Upon standing up from taking his underwear off, he passed out. No biggy (sorta)but he went into what looked like a seizure. We both work with students who have epilepsy and I thought instantly that's what it was. It was followed by odd behavior as he "came out of it" like talking about stuff that wasn't there and blissfully telling me things were OK and smiling way too much. I thought he had had a gran mal, then complex partial seizure.

Once we got to the hospital he was completely normal. They ran all the appropriate tests and told us it seemed like vasovagal. I was still concerned but nonetheless happy. We are having our first child and seizure disorder, well....that would be a tough one for both of us.

After we got home though, he had another weird small "faint" - he was going the bathroom then went to get on the bed and passed out a little. Then when I found him in only a few seconds, he was talking a little crazy again. Slightly slurred speech. So I took him back to the hospital. He came out of it quickly and was again fine at the hospital, but I was so worried.

He was diagnosed there with epilepsy. We were to follow up with a neurologist but the hospital doctor, the same one who diagnosed vasovagal and nothing more, was now certain it was seizures.

My husband, while on the seizure medication continued to have these weird blackouts and then recoup with nonsense while talking. Sometimes he would just very gentle lose his awareness and come back. Usually completely fine and unaware of what happened. Once he has tingly hands afterwards.

For five days he had these weird episodes that happened usually while standing or sitting. One time he was propped up against the bed in a half seating/recline. That's where he had his longest one. 30 seconds of odd movements on the ground and completely blacked out. Then just popped out of it and had no recollection it happened.

On the 6th day, the day we saw the neurologist, they suddenly stopped and have gone away since. He's now back at work and we are slowly taking him off the meds. Our family physician, neurologist and several doctors since then have said it just never seemed like a true seizure but were at a lost as to what I was seeing. However very much aware it seemed a lot like vasovagal.

All tests: MRI, CTs, two EEG's, blood and everything came back normal. He never responded to the meds like he would've if it were seizures. I am almost completely convinced now it is vasovagal because of other peoples information of symptoms.

My husband it 22, completely healthy and fit and we just got out of the Army. But by being severely sick one night and depriving himself of sleep, food and water all day the next for something like car parts put us on this path of hearing "epilepsy" come up again and again. Now hopefully, with everyone basically agreeing (myself included knowing what I saw and watched several times) maybe this "thing" my husband suffered through now has a real name everyone can agree on ... Cherish, 4 October 2006

 

Reading of others' vaso-vagal syncope episodes has been very encouraging to me. Aside from George Bush Sr. (remember when he passed out and threw up at that banquet in Japan years ago?), I didn't know anybody else who has this condition. I've had a total of 7 episodes in my life, but am concerned because their frequency has been increasing lately. Fortunately, I've only sustained one injury after a faint (fell off a chair onto the floor, hit my head and got a black eye), but the fear of another is very troubling. My latest episode was the first time I woke up having urinated instead of thrown up. (Both equally embarrassing.) Now I'm finding that even a week after this episode, I still feel vaguely nauseous off and on, lightheaded and dizzy, afraid that I'm going to pass out again. I've been drinking my usual stomach-calmer, ginger ale, and have added Gatorade to my diet to increase salt intake. Can anyone recommend any other ways to get rid of this persistent nausea? Or does this mean that I haven't recovered from this latest episode? ... Jane Trucksis, 10 October 2006

 

I see lots of postings looking for answers or further research. Has anyone received a response. I too have a serious vasovagal reflex. I had a comprehensive work up last year in 05 including tilt table tests, echos, holter monitor, CT of my head. It was aggravating because even after trying meds, i still failed the tilt test. Yesterday was the first time I have had an episode WHILE LAYING DOWN with my knees up. I was in the process of getting an MRI with contrast for my shoulder. The needle was in my shoulder and I was doing fine. Then of course the symptoms started coming.

I passed out and the nurse said I had seizure symptoms, which I have had in the past but any sort of seizure disorder was ruled out. I was out longer than normal, 30-40 seconds. My problem goes a step futher. WHEN I PASS OUT, MY HEART STOPS. I always come back, so far, but this time it was longer than normal.

I'm a 27 year old seemingly normal professional. I have got to solve this. Hypnosis? Psyche? Magic? I am open for comments... suggestions ... Gregg Field, 7 December 2006

 

Hello. I am Karri Kreilick. I am 13 years old and the tilt table test is for anyone..at any age! I am from ohio and I have neurocardiogenic syncope.

I just recently had the tilt table test done. That is a very successful test and it helps. I have to take FLUDROCORTISONE for the rest of my life. I have been fainting ever since before Kindergarten. I really think that neurocardiogenic syncope has really affected my life in many ways. Its very hard for me to do things such as play sports, run, breathe, and much much more.

I was just going to say that the tilt table test is very successful and that if there is someone out there that you know that has fainting episodes about every now and then, than refer them to go to their doctor and recommend the TILT TABLE TEST ... Karri Kreilick, 11 December 2006

 

 

The information about Dirk was good to hear. I want to find out more about Licorce Root though. I have Neurocardiogenic Syncope. I was diagnosed on May 30,2006. It is true that you shouldn't try to sit while fainting if possible. I have however learned how to faint while seating up without falling by leaning against a wall or something on the side of me like a table or countertop. I faint mostly from losing blood either through injury or through having my period. I have fainted one while moving my bowels, and once by getting stitches removed. This is a serious medical concern for all who have it. I myself consider it an severe medical problem because it means I can't do most jobs. I do try to exercise, eat right and drink plenty of fluids. I hope this helps somebody out there ... Mary Casey, 14 December 2006

 

 

I AM SO BLESSED TO SEE THIS ARTICLE. I RECENTLY HAD AN EPISODE I WAS TOLD IT WAS THE VASOVAGAL NERVE. EMBARASSING ENOUGH IT FELT LIKE I HAD TO USE THE RESTROOM AS SOON AS I SAT DOWN TO DO MY BUSINESS.I HIT THE FLOOR. ALL MY EPISODE HAVE BEEN SOMEWHAT SIMILAR, AND I HAVE INJURED MYSELF. I HAVE ALSO BEEN TOLD IT WAS CAUSED FROM BEING SLEED DEPRIVED. UNTIL THIS YEAR I NEVER KNEW THE NAME OF THIS NOT SO SERIOUS CONDITION. THE THING ABOUT IT IS THAT IT IS A CONDITION NONE THE LESS. IT IS SOMETIMES SCARY, AND EVEN THOUGH YOU HAVE THE LESS THAN A MINUTE WARNING. BEFORE I PASS OUT I SCREAM. I HATE IT. THE LAST TIME I HAD THE EPISODE MY HUSBAND WAS THERE AND MY 2 YEAR OLD. WHEN I WOKE MY HUSBAND WAS OVER ME ,BUT THEN I HEARD MY SON CALLING ME AS WELL. HE WAS SCARED ... Subrina Blue, 25 February 2007

 

 

Thanks for the article by Laurel Jackson on Vasovagal Response. My husband has had three of these episodes during our ten year marriage. During stitches in the ER or minor office surgery at the dermatologists, I at first thought it might be a reaction to the Lidocaine or dehydration. The last proceedure (March 15, '07) in the dermtologists office, the doctor called it a vasovagal response. After research on the internet, I feel that all his episodes were vasovagal. We have prevented his passing out completely by lowering his head to flat, encouraging deep breaths, cool cloths on his forehead, applying oxygen in one situation and smelling salts were also used another time. Certainly being well hydrated in the future before a proceedure will be helpful ... Carole Lusser, 16 March 2007

 

 

This is a very interesting article. In the past two years I've "passed out" twice. Once with stomach pains and the second time from hitting my elbow extremely hard. Knowing to drink plenty of fluids and possibly some extra salt is extremely useful. Thank you for this article! ... Reader on the web, 20 October 2007

 

 

Hello; My name is Sylwia and I'm writing this letter behave my cousin Natalia. Natalia lives in Poland and after many months she was diagnosed with "vasovagal". It was something new to me and my family. She was passing out few times per day, every day. Many times she was landing in a hospital because her heart stopped beating. Few times the doctors had to preside with reanimation and electric shocks. Now she is 18 and because of the fact that she is sick, she can't attend to school anymore. She is still passing out, however not that often as when she was attending school. I'm very concern about her and her health. The doctors in Poland said that they can't do anything. The only hope for Natalia is to wait and see. There is a possibility that when she grow up, she will get better. I'm asking you if you can help my nice Natalia with your knowledge. Maybe there is something that can be done now. The prospective of "just waiting" is really horrible. Natalia is a really great, beautiful and smart person. She is full of live and she deserves a great future ... Sylwia, 2 January 2008