Abstract

Objective

To describe the clinical characteristics of vasovagal syncope (VVS) in patients presenting to a tertiary referral centre with unexplained syncope, in whom the diagnosis of VVS was confirmed by tilt table testing (HUT) and in whom other causes of syncope excluded.

Design

Prospective study of 62 consecutive patients with more than two episodes of syncope in the past year.

Setting

A regional tertiary referral centre for patients with unexplained syncope.

Patients

Sixty-two patients, mean age 50±21 years, 39 female, were studied. Mean duration of symptoms was 5 years. Average frequency of attacks was one episode per week.

Interventions

Detailed semi-structured questionnaires were completed regarding presenting symptoms.

Results

In over one-third of patients, episodes occurred suddenly, with no prodromal features. In those with prodrome, 71% had autonomic symptoms, but 27% had palpitations or dyspnoea and 21% had chest pain.

Eleven percent of patients denied known provocative features. In the remainder, the most common were prolonged standing (37%), hot weather (27%) and lack of food (23%). One-fifth had symptoms sitting and 5% whilst driving.

Seventy-five percent of patients suffered after effects, the most common being severe fatigue. Over half sustained an injury during syncope, and 13% sustained a fracture. Unwitnessed episodes occurred in 25%. Pallor was reported in half the cases, sweating in 13% and myoclonus in 5%.

Conclusions

A typical presentations of VVS occur in many patients referred to a tertiary referral centre. Knowledge of the clinical characteristics of unexplained syncope for which VVS is the attributable diagnosis should assist in appropriate management of such patients.

References

[1]
Kapoor
WN
Karpf
M
Wieand
S
Peterson
JR
Levey
GS
A prospective evaluation and follow-up of patients with syncope
New Engl J Med
 , 
1983
, vol. 
309
 (pg. 
197
-
204
)
[2]
Kenny
RA
Ingram
A
Bayliss
J
Sutton
R
Head-up tilt: a useful test for investigating unexplained syncope
Lancet
 , 
1986
, vol. 
2
 (pg. 
1352
-
1354
)
[3]
Benditt
DG
Ferguson
DW
Grubb
BP
, et al.  . 
Tilt table testing for assessing syncope. ACC Expert Consensus Document
J Am Coll Cardiol
 , 
1996
, vol. 
28
 (pg. 
263
-
275
)
[4]
Almquist
A
Goldenberg
IF
Milstein
S
, et al.  . 
Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope
New Engl J Med
 , 
1989
, vol. 
320
 (pg. 
346
-
351
)
[5]
McIntosh
S
Lawson
J
da Costa
D
, et al.  . 
Use of sublingual glyceryl trinitrate during head up tilt: A provocative test for reproducing neurocardiogenic syncope in unexplained syncope
Cardiol in Eld
 , 
1996
, vol. 
2
 (pg. 
33
-
37
)
[6]
Kapoor
WN
Blanc
JJ
Benditt
D
Sutton
R
Neurocardiogenic causes in the etiology of syncope
Neurally mediated syncope: Pathophysiology, investigations and treatment. The Bakken Research Centre series, vol. 10
 , 
1996
Armonk
Futura
(pg. 
57
-
60
)
[7]
Lewis
T
Vasovagal syncope and the carotid sinus mechanism
BMJ
 , 
1932
, vol. 
1
 (pg. 
873
-
876
)
[8]
Wayne
HH
Syncope. Physiological considerations and an analysis of the clinical characteristics in 510 patients
Am J Med
 , 
1961
, vol. 
30
 (pg. 
418
-
438
)
[9]
Sutton
R
Vasovagal syncope — could it be malignant?
Eur J Cardiac Pacing Electrophysiol
 , 
1992
, vol. 
2
 pg. 
89
 
[10]
Sutton
R
Petersen
ME
The clinical spectrum of neurocardiogenic syncope
J Cardiovasc Electrophysiol
 , 
1995
, vol. 
6
 (pg. 
569
-
576
)
[11]
Mathias
CJ
Deguchi
K
Bleasdale-Barr
K
Kimber
JR
Frequency of family history in vasovagal syncope
Lancet
 , 
1998
, vol. 
352
 (pg. 
33
-
34
)
[12]
Calkins
H
Shyr
Y
Frumin
H
Schork
A
Morady
F
The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope
Am J Med
 , 
1995
, vol. 
98
 (pg. 
365
-
373
)
[13]
Sheldon
R
Koshman
ML
Can patients with neuromediated syncope safely drive motor vehicles?
Am J Cardiol
 , 
1995
, vol. 
75
 (pg. 
955
-
956
)
[14]
Taylor
DP
Medical aspects of fitness to drive
[15]
Sloane
PD
Linzer
M
Pontinen
M
Divine
GW
Clinical significance of a dizziness history in medical patients with syncope
Arch Int Med
 , 
1991
, vol. 
151
 (pg. 
1625
-
1628
)
[16]
McIntosh
SJ
Lawson
J
Kenny
RA
Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly
Am J Med
 , 
1993
, vol. 
95
 (pg. 
203
-
208
)
[17]
Grubb
BP
Gerard
G
Roush
K
, et al.  . 
Differentiation of convulsive syncope and epilepsy with head-up tilt testing
Ann Int Med
 , 
1991
, vol. 
115
 (pg. 
871
-
876
)