Treatment for vasovagal syncope should begin by explaining to the patient the benign nature of the condition. The person experiencing it should remain calm, as it is a minor problem. When vasovagal syncope occurs for the first time, it should not be considered an illness and does not require any treatment.
However, if syncope recurs, especially if it is frequent, it can significantly affect the patient’s quality of life. In this case, a more in-depth evaluation, treatment, and periodic monitoring are required. For this purpose, the patient should always consult a cardiologist with experience in this condition.
Detecting arrhythmias in patients with syncope
The first step in evaluating a patient with syncope is to assess the risk that the loss of consciousness is due to a serious arrhythmia. Recording an electrocardiogram during the syncope allows physicians to confirm or rule out an arrhythmia as the mechanism of the syncope.
To record an electrocardiogram at the time of syncope, the use of a Holter monitor is usually necessary. These typically record for 24–48 hours, although longer durations are available. External loop recorders or implantable recorders are placed under the patient’s skin. These record continuously in a loop for up to three years (battery life).
Many studies have analyzed the usefulness of long-term recorders in unexplained or high-risk recurrent vasovagal syncope. These studies suggest that early use of recorders provides more diagnostic benefits. This may help in the selection of patients with vasovagal syncope and prolonged asystolic pauses (absence of a heartbeat), who might benefit from a pacemaker.
Vasovagal Syncope Treatment
- First-line treatment is based on a series of general recommendations aimed at increasing cerebral blood flow. It is advisable to drink plenty of fluids, generally about 2 liters of water a day, and eat a balanced diet. Standing still for long periods of time should be avoided. While standing, it is good to perform leg contractions. When sitting, your feet should be elevated.
- For some people, so-called “orthostatic training” is helpful. It consists of standing still at home, next to an armchair or bed (to lie down if necessary), and increasing the time spent in this position each day. It is also recommended to sleep with the head of the bed slightly elevated. This allows exposure to gravity during sleep and prevents sudden changes in posture upon waking in the morning.
- Waist-high compression stockings are effective for some people. Finally, if all of the above is not sufficient, syncope prevention should be attempted with medication. Unfortunately, medication is not effective in all cases. Different drugs have been tried with highly variable results. The cardiologist should always prescribe the most appropriate medication for each individual.
- Patients with repetitive vasovagal syncope preceded by symptoms should also be familiar with some methods to try to stem the attack and prevent loss of consciousness. If they begin to experience dizziness or generalized weakness, or other warning symptoms, the most effective approach is to lie down and elevate their legs. This immediately increases cerebral blood flow.
- Since the intention is always to divert blood from the limbs to the head, it is also helpful to cross the legs and squeeze them tightly. Likewise, flex the arms and clench the fists, or squat. Finally, if the patient loses consciousness, the person accompanying them should lie them down and elevate their legs. This usually leads to a full recovery, which usually occurs within seconds or a few minutes.
It is common to observe how, when a person faints, those trying to help immediately lift them and place them on their feet. This is a serious mistake, as standing them up further reduces the flow to the head and prolongs the loss of consciousness.
Although multiple studies have been conducted, truly useful advances in the treatment of vasovagal syncope have been limited. Once the possibility of syncope due to an arrhythmia has been ruled out and the syncope diagnosed as vasovagal, treatment is difficult. No truly effective remedy has been found.
Several studies have shown that patient education is the most effective method. Patients should be fully aware of what vasovagal syncope is. Applying physical measures to prevent loss of consciousness is the most effective method for treating the problem. Drugs are less effective, although they may be helpful in some cases. Pacemakers are necessary in a few patients. Ablation is under investigation.
Pacemaker in Vasovagal Syncope
Numerous attempts have been made to determine whether patients with vasovagal syncope with a predominantly cardioinhibitory response (due to a significant decrease in heart rate) would benefit from permanent pacemaker implantation, especially if symptoms are frequent or debilitating.
The first open-label trials of pacemakers in the treatment of vasovagal syncope showed promising results. However, this effect has not been confirmed by randomized, blinded clinical trials. More recent data seem to suggest that patients over 40 years of age with severe vasovagal syncope due to asystole could benefit from permanent pacing.
The indication of a pacemaker for neurocardiogenic or vasovagal syncope has been considered for decades. However, studies have not been entirely conclusive. The advent of the tilt table test in 1986 demonstrated that some patients with vasovagal syncope had asystole. Therefore, pacemakers began to be indicated in these cases. However, subsequent studies did not show an obvious benefit.
The subsequent advent of loop recorders has made it possible to document cardiac rhythm during episodes. This has allowed for improved patient selection for pacing. Loop recorders are used to demonstrate asystole in spontaneous syncope when the tilt table test is negative. This implies a lower vasodepressor component, so, in theory, the patient will have a better outcome with a pacemaker. Based on the available evidence, a dual-chamber pacemaker should be used in patients over 40 years of age with severe symptoms and in whom standard measures have demonstrably failed.
Natural Treatment for Vasovagal Syncope
To prevent vasovagal syncope, it is recommended to implement hygienic and dietary measures, especially drinking plenty of water and eating with salt. These measures are aimed at increasing blood pressure and cerebral blood flow.
In addition, some people also use natural remedies that raise blood pressure. In this regard, the most effective is the regular consumption of licorice, although it has not been scientifically studied in the treatment of vasovagal syncope. Licorice has a mild corticosteroid effect, promoting water and sodium retention, thereby increasing blood pressure. Used in low doses, it can help maintain blood pressure and prevent low blood pressure, making it effective in preventing dizziness and syncope due to hypotension.
Licorice is useful for improving gastric and intestinal problems, so it is recommended to take it half an hour before meals. Used at the recommended doses, it usually has no side effects. Since it promotes potassium loss, it is advisable to consume fruits and vegetables rich in this element, such as bananas, chard, cabbage, and spinach. On the other hand, since it increases blood pressure, it is contraindicated in cases of hypertension.
Other useful natural remedies for vitality that can increase blood pressure include ginseng, maca, reishi, rosemary, and ginger. These are mild stimulants of the nervous system, have been used as revitalizing tonics, and they modestly raise blood pressure. These remedies also do not usually produce side effects when used at the recommended doses. Finally, yoga has also been shown to be beneficial in reducing episodes and improving the quality of life of patients with vasovagal syncope.
