Before losing consciousness, some of the early signs and symptoms presented by vasovagal syncope patients include lightheadedness, nausea, extremely high or extremely low body temperature (often followed by sweating), tinnitus, palpitations, confusion, a slight inability to speak, often followed by mild stuttering, nervousness and visual disturbances are other symptoms that can occur as well [8].

The symptoms often last for a few seconds before the loss of consciousness begins. The loss of consciousness often happens when the individual is sitting up or standing. As soon as the sufferer passes out, they fall down. At this point blood flow to the brain is restored instantaneously. A seizure may result if the individual doesn’t fall into a fully flat supine position and the head stays elevated above the trunk as blood will unable to quickly return to the brain. 

• Falling

  These new data seem to indicate that some unexplained falls could be cases of atypical VVS/carotid sinus syncope with retrograde amnesia. [ncbi.nlm.nih.gov]

  As soon as the sufferer passes out, they fall down. At this point blood flow to the brain is restored instantaneously. [symptoma.com]

  […] syncope 10 s or asystole for >3 s BP falls to Type 3 Pure vasodepressor Heart rate does not fall more than 10% from its peak at syncope Fall in BP precipitates syncope Figure 1. [academic.oup.com]

• Weakness

  Signs of weakness localized to certain areas of the body with temporary loss of consciousness suggest stroke. The blood pressure and pulse are tested in the lying, sitting, and standing positions. [medicinenet.com]

  Statistical significance was achieved for the analysed signs such as generalized weakness, dyspnea, heart palpitations, cold sweats, feeling of cold or heat, visual disturbances, tinnitus, headache. [ncbi.nlm.nih.gov]

  […] vision — your field of vision is constricted so that you see only what's in front of you Nausea Feeling of warmth A cold, clammy sweat Yawning Blurred vision During a vasovagal syncope episode, bystanders may notice: Jerky, abnormal movements A slow, weak [fortishealthcare.com]

  Share on Pinterest Lightheadedness, dizziness, and weakness can be signs that a person will faint. Some people who experience VVS do not notice any warning signs before fainting. [medicalnewstoday.com]

• Unconsciousness

  We need to be aware of unconsciousness because of phobia when trying to insert contact lenses. [ncbi.nlm.nih.gov]

  When the blood flow to your brain decreases you will most likely become faint or dizzy and you can become unconscious. [gazettereview.com]

  This results in a sudden loss of blood flow to the brain, which leads to equally sudden unconsciousness. [buoyhealth.com]

  Prolonged unconsciousness, lasting more than 5-10 minutes once lying down. [jpaget.nhs.uk]

  [citation needed] The main danger of vasovagal syncope (or dizzy spells from vertigo) is the risk of injury by falling while unconscious. [en.wikipedia.org]

• Collapse

  There is a subgroup of vasovagal syncope (VVS) patients, who demonstrate sinus tachycardia before collapse on tilt testing mimicking some features of POTS. These patients may also respond to ivabradine therapy. [ncbi.nlm.nih.gov]

  ICD-10-CM Codes › R00-R99 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified › R50-R69 General symptoms and signs › R55- Syncope and collapse › Syncope and collapse 2016 2017 2018 2019 Billable/Specific Code R55 is [icd10data.com]

  Symptoms that are more worrying, and suggest the collapse may not be just a simple faint are: Chest pain, severe breathlessness or severe headache before collapsing Fitting with stiffness and/or jerky movements immediately on collapsing Not breathing [jpaget.nhs.uk]

• Anemia

  Synonym(s): vasodepressor syncope. vasovagal syncope See FAINTING. syncope a temporary suspension of consciousness due to cerebral anemia; fainting. cardiac syncope sudden loss of consciousness due to cerebral anemia caused by ventricular asystole, extreme [medical-dictionary.thefreedictionary.com]

  Strong consideration should be given to fecal blood testing in patients in whom blood loss anemia is suspected, as hemoglobin may be normal in patients with acute hemorrhage. [ncbi.nlm.nih.gov]

  Mild blood loss, poor physical condition, prolonged bed rest, anemia, fever, organic heart disease, and fasting are other factors which increase the possibility of fainting in susceptible individuals. [healthcentral.com]

• Sighing

  […] measures are taken Light-headedness Swimming sensation Dizziness ‘Cold sweat’ Fatigue Blurred and fading vision Palpitations (in young patients) Sounds ‘coming from a distance’ Buzzing in the ears Just prior to the faint Facial pallor (or green) Yawning Sighing [syncopedia.org]

• Nausea

  Patients with nausea or extreme anxiety should be watched carefully and their symptoms treated. [ncbi.nlm.nih.gov]

  Clinical findings Abrupt loss of vascular tone; nausea; diaphoresis; pallor. [medical-dictionary.thefreedictionary.com]

  They may complain of symptoms including nausea, abdominal pain, clamminess, tremors, lightheadedness, headache, malaise, exhaustion and confusion. [pccoforegon.com]

• Vomiting

  U of Washington Study (2) Of those having symptoms Feeling of faintness or dizziness (85%) Nausea (50%) Feeling hot (31%) or cold (21%) Pallor (79%) Sweating (57%) Vomiting or loss of consciousness (0%) Pavlin, et. al. (1993) 16. [slideshare.net]

  Presyncopal (near fainting) patients may also complain of vomiting, disorientation, and difficulty speaking or seeing. [pccoforegon.com]

  […] your chances of fainting: Standing still in one position for a period of time Stressful or emotional situations Hot or warm areas Not eating or drinking enough Seeing blood or having injections Please be aware that if you are unwell with diarrhoea or vomiting [rbht.nhs.uk]

  Just before fainting the person may experience a racing heart, feeling of warmth or cold, yawning, vomiting, difficulty talking or disorientation. [childrensheartcentre.com]

• Diarrhea

  […] i.e. vision getting "dark" or "closing in"). [2] Causes [ edit ] Lightheadedness can be simply (and most commonly) an indication of a temporary shortage of blood or oxygen to the brain due to a drop in blood pressure, rapid dehydration from vomiting, diarrhea [en.wikipedia.org]

  It's often accompanied by other symptoms of the dysautonomias, such as: Abdominal bloating or cramps Diarrhea Constipation Extreme fatigue Various aches and pains When to See a Healthcare Provider Contact your doctor if you experience your first-ever [verywellhealth.com]

  They often have other symptoms typical of the dysautonomias, such as abdominal bloating or cramps, diarrhea, constipation, extreme fatigue, and various aches and pains. [heartdisease.about.com]

  Intravascular volume depletion due to vomiting, diarrhea, or hemorrhage can result in OH. [clevelandclinicmeded.com]

  anxiety, nervousness Ephedrine sulfate 12.5–25 mg PO TID Tachycardia, tremor, supine hypertension Fluoxetine 10–20 mg PO QD (requires 4–6 weeks of therapy) Nausea, anorexia, diarrhea, agitation Venlafaxine 75 mg XR form PO QD or BID Nausea, anorexia [circ.ahajournals.org]

• Hypotension

  Table 5: Abnormal Hemodynamic Patterns During Tilt Test Vasovagal response Cardioinhibitory response, hypotension and bradycardia or asystole Vasodepressor response, hypotension without bradycardia Mixed response Postural hypotension Reduction in systolic [clevelandclinicmeded.com]

  POTS has recently been conflated with VVS when excessive tachycardia is succeeded by hypotension during tilt testing. [ncbi.nlm.nih.gov]

  The body's overreaction to a given trigger causes a sudden drop in both heart rate and blood pressure (hypotension). [cumming.ucalgary.ca]

  Vasovagal Presentation Hypotension that may be followed by paradoxic bradycardia May cause increased rate and depth of respirations Pulse may increase initially and then decrease Patients may be hypotensive without bradycardia 7. [slideshare.net]

• Orthostatic Hypotension

  Both types of syncope are associated with orthostatic hypotension and are nonlethal. The underlying pathophysiology manifests the vast symptoms suffered by the individual. [ncbi.nlm.nih.gov]

  Update on the evaluation, pathogenesis and management of neurogenic orthostatic hypotension. Neurology 1995; 45(4 suppl 5):S4–S5. Streeten DHP, Anderson GH Jr. Mechanisms of orthostatic hypotension and tachycardia in patients with pheochromocytoma. [clevelandclinicmeded.com]

  Orthostatic Hypotension (2) Treatment Lie down Trendelenberg position NS Regulate medications 24. [slideshare.net]

  ( I95.1 ) G90.3 ) orthostatic hypotension ( ICD-10-CM Diagnosis Code I95.1 Orthostatic hypotension 2016 2017 2018 2019 Billable/Specific Code Applicable To Hypotension, postural Type 1 Excludes neurogenic orthostatic hypotension [Shy-Drager] ( G90.3 [icd10data.com]

  Orthostatic Hypotension In orthostatic hypotension (postural hypotension), patients tend to faint on standing. One typical cause is depleted extracellular fluid volume, perhaps due to use of a diuretic. [courses.washington.edu]

• Slow Pulse

  The pulse rate slows: Due to the disturbance in the vagus nerve control, the pulse rate slows. This combination of low blood pressure and low pulse rate causes the blood to pool in the legs instead of going to the brain. [buoyhealth.com]

  Profuse sweating Slow pulse. Once an attack starts, the following are likely to happen: Loss of consciousness and falling to the ground, usually for no more than 15 seconds. Eyes remain open but roll up and back into your head. [my.clevelandclinic.org]

• Sweating

  Severe sinus bradycardia and hypotension accompanied by light-headedness, cold sweating, and nausea occurred at 80 degrees head-up position during 4 micrograms/min isoproterenol infusion. [ncbi.nlm.nih.gov]

  After the nerve is stimulated, the heart rate slows, lowering BP and causing sweating and eventually a loss of consciousness. [journals.lww.com]

  Before you faint due to vasovagal syncope, you may experience some of the following: Skin paleness Lightheadedness Tunnel vision — your field of vision is constricted so that you see only what's in front of you Nausea Feeling of warmth A cold, clammy sweat [fortishealthcare.com]

• Hyperhidrosis

  It can present with a prolonged prodrome characterized by dizziness, fatigue, weakness, palpitations, hearing and vision disturbances, hyperhidrosis, low back pain, neck or precordial pain; followed by rapid syncope. 1 Postural (orthostatic) tachycardia [clevelandclinicmeded.com]

• Anxiety Disorder

  For a referral, check with the Association for Behavioral and Cognitive Therapies (www.aabt.org) or the Anxiety Disorders Association of America (www.adaa.org). [webmd.com]

  Medication In some cases, drugs used to treat low blood pressure or anxiety disorders may be prescribed. [baptisthealth.com]

  Disgust, anxiety, and vasovagal syncope sensations: a comparison of injection-fearful and nonfearful blood donors. J Anxiety Disord 2010;24:941-5. Crossref | PubMed Owens AP, Low DA, Critchley HD, Mathias CJ. [aerjournal.com]

  Disgust, anxiety, and vasovagal syncope sensations: a comparison of injection-fearful and nonfearful blood donors. J Anxiety Disord. 2010; 24 :941–5. doi: 10.10/j.janxdis.2010.06.021. [ PubMed ] [ CrossRef ] [ Google Scholar ] 23. [ncbi.nlm.nih.gov]

  […] ranging from conversion reactions to anxiety disorders and major depression. 45 Individuals with conversion reactions are not consciously aware of their actions. [circ.ahajournals.org]

• Fidgeting

  Many people with neurocardiogenic syncope develop adaptations to keep from fainting, such as crossing their legs, fidgeting, or sitting or lying down when they get lightheaded or tired, but the tilt table test prohibits them from performing those natural [pacemakerclub.com]

• Dizziness

  A 16-year-old healthy boy had sometimes experienced dizziness when looking at the tips of pens. When he put his finger and the lens close to his eye to insert a soft contact lens, he felt sick and dizzy and fell unconscious. [ncbi.nlm.nih.gov]

  Although the prodromal symptoms of dizziness, sweating and nausea may classically precede the syncope or fainting, signs and symptoms and also frequency of syncope may vary among patients. [ajconline.org]

  It is also important for patient’s to recognize the feeling of dizziness so that they can react appropriately to their body's signals and either sit or lie down quickly. Once the dizziness has passed, they can slowly stand up again. [pediatricheartspecialists.com]

  This helps more blood to flow to your brain and may help relieve symptoms like feeling dizzy. Some doctors may recommend a technique that involves tensing your fists and arms. This type of fainting is often easy to predict. [myhealth.alberta.ca]

• Confusion

  As soon as there is a slow-down in heart rate, the resulting lack of blood to the brain brings about fainting and confusion. [symptoma.com]

  However, these fainting spells can be accompanied by confusion, jerking movements and loss of consciousness much like an epileptic seizure. At times, patients’ pupils may dilate and be noticed by others prior to fainting. [rscdiagnosticservices.com]

  They may complain of symptoms including nausea, abdominal pain, clamminess, tremors, lightheadedness, headache, malaise, exhaustion and confusion. [pccoforegon.com]

• Vertigo

  It is very important to differentiate vertigo, seizures, light-headedness, seizures, vertigo and hypoglycaemia as other causes. [symptoma.com]

  See also [ edit ] Orthostatic hypotension Dizziness Vertigo Vasovagal response Clouding of consciousness Greyout References [ edit ] External links [ edit ] The MedlinePlus Medical Encyclopedia [en.wikipedia.org]

  […] sĭng′kə-pəl, sĭn′-), syn·cop′ic (sĭn-kŏp′ĭk) adj. syncope Neurology A transient loss of consciousness not explained by other altered states of consciousness in the history of the Pt, often linked to cerebral ischemia; fainting, loss of conciousness or vertigo [medical-dictionary.thefreedictionary.com]

  […] tool=bestpractice.com It has many causes, and is distinct from vertigo, seizures, coma, falls, psychogenic pseudosyncope, drop attacks, transient ischaemic attacks, and states of altered consciousness. [3] Strickberger SA, Benson DW, Biaggioni I, et al [bestpractice.bmj.com]

• Drop Attacks

  These falls/attacks are called cryptogenic drop attacks. References:[5][12] The differential diagnoses listed here are not exhaustive. Treatment Complications References:[5] We list the most important complications. The selection is not exhaustive. [amboss.com]

  Autonomic failure 8.1.2 Epilepsy and ictal asystole 8.1.3 Cerebrovascular disorders 8.1.4 Migraine 8.1.5 Cataplexy 8.1.6 Drop attacks 8.2 Neurological tests 8.2.1 Electroencephalography 8.2.2 Brain computed tomography and magnetic resonance imaging 8.2.3 [escardio.org]

  […] tool=bestpractice.com It has many causes, and is distinct from vertigo, seizures, coma, falls, psychogenic pseudosyncope, drop attacks, transient ischaemic attacks, and states of altered consciousness. [3] Strickberger SA, Benson DW, Biaggioni I, et al [bestpractice.bmj.com]

  Drop attacks. Dizziness or vertigo without loss of consciousness. Alcohol/drug abuse. Transient ischaemic attacks / stroke. Psychogenic pseudosyncope. See also separate Dizziness, Giddiness and Feeling Faint article. [patient.info]

  attacks” that occur with little warning. [circ.ahajournals.org]

• Asthenia

  2018 2019 2020 Billable/Specific Code Applicable To Carotid sinus syndrome G90.01) heat syncope ( ICD-10-CM Diagnosis Code T67.1 Heat syncope 2016 2017 2018 2019 2020 Non-Billable/Non-Specific Code Applicable To Heat collapse T67.1) neurocirculatory asthenia [icd10data.com]

  The origin of the term neurocirculatory asthenia. N Engl J Med. 1965 Sep 9;273:604-5. | PubMed | Chávez I. Cinco Lecciones de Clínica Cardiológica. Méndez Oteo; 1933. Wood P. Da Costa's Syndrome: Aetiology. Lecture III. [medwave.cl]

• Urinary Incontinence

  incontinence (in < 25 %; faecal incontinence is very rare) Abnormal breathing Post-syncopal signs and symptoms After syncope Consciousness recovers quickly Fatigue Persistent pallor Nausea Yawning Weakness Sweating Oliguria Recurrence when standing up [syncopedia.org]

There are many medical conditions that may cause syncope. This is why making the correct diagnosis for loss of consciousness is one of the most difficult challenges facing health care providers. The core of the diagnosis of vasovagal syncope is dependent on a clear description by the patient for a particular pattern of triggers and time course. It is very important to differentiate vertigo, seizures, light-headedness, seizures, vertigo and hypoglycaemia as other causes.

For patients with recurring vasovagal syncope, the accuracy of diagnosis can often be improved with any one of the following diagnostic tests [9]:

• Tilt table test
• Echocardiogram
• Holter monitor or event monitor
• Implantation of an insertable loop recorder
• Electrophysiology study

• Sinus Arrest

  Vasovagal syncope with concomitant ventricular asystole and sinus arrest is rare. Aggressive management with permanent pacemaker is strongly advocated in malignant vasovagal syncope. [ncbi.nlm.nih.gov]

  Facts While standing, approximately 300-700 ml of blood pools in the lower extremities which decreases intravascular volume Strong vagal stimulations may induce 4-10 seconds of sinus arrest 15 seconds of asystole is necessary to produce unconsciousness [slideshare.net]

  The increased in vagal tone which is the final common pathway for the precipitation of syncope results in both sinus arrest and AV block. As such, single chamber atrial pacing is not recommended for this would not support the ventricle. [fac.org.ar]

Applied tension is a behavioral treatment approach that has been demonstrated to be efficacious for the treatment of vasovagal syncope associated with injection phobia. [ncbi.nlm.nih.gov]

What will treatment most likely be? 31. [slideshare.net]

When there is a question about the syncope etiology or when immediate evaluationor treatment is needed, hospitalization isappropriate. [aafp.org]

VVS in patients with LV dysfunction may be refractory to treatment and could be associated with poor prognosis. KEYWORDS: Autonomic nervous system; Head-up tilt; Left ventricular dysfunction; Vasovagal syncope [ncbi.nlm.nih.gov]

However, it has not been demonstrated that it has value for establishing the prognosis or selecting treatment. [revespcardiol.org]

All aspects of VVS are covered, including epidemiology, pathophysiology, diagnosis and differential diagnosis, prognosis, therapy and implications for particular activities such as work, driving and physical activity. [springer.com]

Short- and long-term prognosis of syncope, risk factors, and role of hospital admission: results from the STePS (short-term prognosis of syncope) study. J Am Coll Cardiol 2008; 51:276–283. Vaddadi G, Guo L, Esler M, et al. [clevelandclinicmeded.com]

Vasovagal syncope often occurs in response to a trigger and there is often a corresponding malfunction in the parts of the nervous system which regulate the heart rate and blood pressure [4]. As soon as there is a slow-down in heart rate, the resulting lack of blood to the brain brings about fainting and confusion.

Below are some of the main triggers for vasovagal episodes:

• Sensitivity as a result of pain
• Extreme menstural pains
• Pressure on the chest after heavy exercising
• Being present during medical procedures
• Sight of blood
• Biopsy procedures (pre and post)
• Increased stress levels
• Dehydration
• Ingestion of certain medications and addcitive substances
• Heavy emotional swings
• Nervous malfucntions
• In rare cases, low sugar level in blood

The incidence for this condition is 6.2 cases per 100 patient years in the United States [5]. Syncope also reoccurs in less than 3% of affected individuals and also, 10% of affected individuals have a cardiac etiology. Data from around the world also suggest a similar occurrence rate to what is obtainable in the United States.

Vasovagal syncope occurs as a result of cerebral hypoperfusion [6]. Brain parenchyma is dependent on sustained blood flow to be able to provide a constant supply of glucose which is its major metabolic substrate. It is not possible for the brain tissue to store energy in form of high-energy phosphates as is seen in other areas of the body. This is why cerebral perfusion of between 3 to 5 seconds is enough to bring about syncope.

Cerebral perfusion is maintained relatively constant by an intricate and complex feedback system which typically involves arterial pressure, intravascular volume status, metabolic regulation and cerebrovascular resistance with intrinsic autoregulation. When there is a significant defect in any of these or subclinical defects in several of these systems, syncope may arise.

Past studies found that an Anti-Gravity suit (G-suit) can increase blood pressure and has been reported to prevent orthostatic hypotension effectively in patients with diabetes. It is possible that the G-suit can prevent VVS. [ncbi.nlm.nih.gov]

While syncope continued to occur in 5 patients, it was prevented in 17 although other premonitory symptoms including presyncope continued. In this same group of patients, beta blockade therapy prevented all symptoms in only 10 of 22 patients (40%). [fac.org.ar]

Syncope refers to a self-limited loss of consciousness accompanied by the inability to maintain postural tone. Most of the time, it is followed by spontaneous recovery [1]. The condition doesn’t include seizures, coma, shock or other such states of altered consciousness.

There are many recognised etiologies for syncope but categorization is made into reflex (neutrally mediated), orthostatic and cardiac so as to ensure proper initial evaluation [2]. Cardiac vasovagal syncope has the highest number of mortality while non-cardiac syncope doesn’t have such high mortality. Syncope can result in significant morbidity due to accidents or falls that may occur following its onset [3].

Vasovagal syncope refers to one of the most common causes of fainting. It occurs when the body begins to overreact to certain triggers. The most common triggers are sight of blood and extreme emotional distress.

The vasovagal syncope trigger kicks off a sudden drop in heart rate and blood pressure. This brings about a reduction in blood flow to the brain which leads to a momentary loss of consciousness.

The condition is often harmless requiring no treatment. However, it is possible for patients to get injured during an episode of the condition. The doctor may recommend tests to rule out more serious cases of fainting such as an underlying heart condition.