# Vasovagal Syncope Symptoms, Causes & Tests | OSANG Neurosurgery > Learn about vasovagal syncope, which can cause sweating, dizziness, or fainting during stress or prolonged standing, and about assessment, tilt-table testing, and daily management. - Official page: https://osns.co.kr/en/autonomic/vasovagal-syncope/ - Organization: OSANG Neurosurgery ## Page content ## Autonomic Clinic ## Sudden drop in blood pressure and heart rate, Blood flow to the brain is briefly reduced. Vasovagal syncope is the most common form of neurally mediated syncope in which the vagus nerve becomes excessively activated, causing a sudden drop in heart rate and blood pressure, resulting in a temporary decrease in cerebral blood flow, resulting in loss of consciousness. It accounts for approximately 56-66% of all causes of syncope, and most have a benign course without any life-threatening effects. ### What is vasovagal syncope? Vasovagal syncope (VVS) is a representative form of neurally mediated syncope in which bradycardia and vasodilation occur simultaneously due to excessive activity of the vagus nerve, resulting in a temporary decrease in cerebral blood flow and loss of consciousness. Syncope is a type of transient loss of consciousness caused by global cerebral hypoperfusion and is characterized by complete spontaneous recovery. VVS is the most common type of syncope, accounting for approximately 56-66% of all causes of syncope, with approximately 40% of the general population experiencing syncope at least once in their lifetime. The most common first occurrence is between the ages of 10 and 30, and the incidence is slightly higher in women than in men. VVS itself is a benign disease that is not life-threatening, but repeated occurrences can be accompanied by a risk of trauma and decreased quality of life. ## What symptoms do you experience? In vasovagal syncope, warning symptoms (prodromal symptoms) appear first before syncope, and most people recover spontaneously within a few seconds to a minute after loss of consciousness. Check out the representative symptoms at each stage. ### Prodromal symptoms (warning symptoms before fainting) ### Loss of consciousness (syncope) ### Bradycardia and transient cardiac arrest ### convalescent symptoms ## Why does it happen? Vasovagal syncope occurs when, in addition to the core mechanism of overactive vagal reflexes, various triggers such as standing, emotions, and the body overlap. ### Bezold-Jarish reflex (key mechanism) ### Triggers related to standing ### Emotion/pain-related triggers ### physical triggers ### Situational syncope and carotid sinus hypersensitivity ## How is it diagnosed? In diagnosing vasovagal syncope, a detailed history is most important, and the tilt table test is a standard diagnostic tool. A cardiac examination and autonomic function test (HRV) are performed together to differentiate cardiogenic syncope. When diagnosing VVS, taking the medical history is most important. Tilt table testis a standard diagnostic tool. During the history taking, typical triggers (prolonged standing, pain, heat, emotional stress, etc.), presence of prodromal symptoms, position at onset of syncope, witness statements, duration, presence or absence of convulsions, status after recovery, family history, history of heart disease, and medication history are systematically checked. The 2018 European Society of Cardiology (ESC) guidelines state that typical VVS can be diagnosed based on history alone if typical precipitating factors and prodromes are present, organic heart disease is excluded, and there are no neurological abnormalities. The standing incline table test involves continuously measuring changes in blood pressure and heart rate by having the patient lie down on an examination table with a seat belt and tilting it at an angle of 60 to 70 degrees for 20 to 45 minutes. If syncope is reproduced and a drop in blood pressure and bradycardia are confirmed, the patient is judged positive. If there is no response to the basic test, a drug challenge test is performed using sublingual nitroglycerin or intravenous isoproterenol. The sensitivity of this test is approximately 61-69% and specificity is approximately 93%, and reproducibility is not perfect, so a negative result does not exclude VVS. ### Standing incline table examination ### ECG, echocardiogram, Holter ### Heart rate variability (HRV) test ## How do I treat and manage it? Vasovagal syncope is mostly controlled with non-pharmacological treatments such as patient education, lifestyle management, and physical counterpressure. For repetitive cardiac suppression type, drug or pacemaker insertion is considered step by step. ### Patient education and trigger avoidance ### Physical counterpressure (primary treatment, ESC Class I recommended) ### Water and salt intake ### Stand training (tilt training) ### medication ### pacemaker insertion ### Neural Reset Protocol ### NPT Program FAQ ## Frequently Asked Questions We have collected the most frequently asked questions from patients about vasovagal syncope. ### Q1What is vasovagal syncope? Vasovagal syncope is a phenomenon in which the vagus nerve is suddenly excessively activated, causing both heart rate and blood pressure to drop, resulting in temporary loss of consciousness. It is the most common cause of fainting and can occur even in healthy people. In most cases, it has a benign course without any life-threatening effects, but if it recurs, the quality of life can significantly decrease, so accurate diagnosis and management are necessary. ### Q2Is it dangerous to have repeated fainting? Vasovagal syncope itself is not a structural abnormality of the heart and is therefore not life-threatening. However, if you faint and fall, head trauma or fractures can occur, and if you fall while driving or from a high place, it can lead to a serious accident. Additionally, repeated fainting causes psychological anxiety and social withdrawal. If fainting occurs more than twice, be sure to seek medical attention. ### Q3What are the signs before fainting? In most cases of vasovagal syncope, a prodrome first appears. Symptoms such as darkening or blurring in front of the eyes, dizziness, nausea, cold sweat, pale face, and a feeling of ear fullness may precede the symptoms for a few seconds to several minutes. If you feel these prodromal symptoms, immediately sit or lie down and raise your legs to prevent fainting. Training to recognize prodromal symptoms is very helpful in preventing recurrence. ### Q4How is the standing tilt table examination performed? The tilt table test is a standard test to determine the cause of syncope. While lying down on an examination table with a seat belt and tilted at an angle of 60 to 70 degrees, blood pressure and heart rate are continuously monitored for 20 to 45 minutes. If syncope is repeated during the test and a drop in blood pressure and bradycardia are confirmed, vasovagal syncope is diagnosed. The examination process is carried out safely, and even if fainting occurs, you can rest assured that you will immediately lie down on the examination table and recover. ### Q5How is vasovagal syncope treated? The most basic thing is to avoid triggers (standing for long periods of time, dehydration, heat, overwork, etc.). Sufficient water intake of 2 to 3 liters per day and appropriate salt supplementation are recommended. When you feel prodromal symptoms, you can prevent fainting by performing physical counter-pressure techniques such as crossing your legs and pulling your arms. Many patients are able to control their symptoms with these non-drug treatments alone, but if the condition recurs, drug treatment is considered. We recommend that you consult with a specialist to develop a management plan that is right for you. ### Q6How should people around me help me when I faint? If the patient falls, first lay them down in a safe place and raise their legs higher than their heart. Loosen any tight clothing (tie, belt, etc.) and turn your head to the side to open the airway. Vasovagal syncope usually resolves spontaneously within 1 to 2 minutes. If you do not regain consciousness for more than 5 minutes or are accompanied by convulsions, seek help from an emergency medical facility. Please instruct the patient to lie down for at least 10 minutes immediately after recovering from fainting, rather than getting up immediately. ## Do you suspect vasovagal syncope? If fainting occurs even once, specialist consultation is required to determine the cause. Gangnam Osang Neurosurgery Autonomic Nerve Clinic provides accurate examination and customized management. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.