Abstract
Since the classic Lewis’ description of vasovagal syncope (VVS) in 1932, our knowledge on VVS has markedly improved, and we have learned that VVS may have different clinical presentations. The most relevant ones are typical VVS, sleep syncope, atypical VVS, and unexplained fall. Moreover, even sudden death may be a clinical presentation of VVS, when the emotional vasovagal reflex occurs simultaneously with the diving reflex. Typical VVS can be diagnosed after the initial evaluation, when a transient loss of consciousness is triggered by emotional distress or orthostatic stress, in the presence of autonomic prodromes. An atypical VVS can be diagnosed in subjects with transient loss of consciousness not preceded by evident trigger, only when tilt test is positive, in the absence of any competing diagnosis. Many clinical features suggest that sleep syncope is a form of VVS. Very recent data show that an unexplained fall may be a clinical presentation of VVS.
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References
Lewis T (1932) Vasovagal syncope and the carotid sinus mechanism. BMJ 1:873–876
Alboni P. Different clinical presentations of vasovagal syncope. Sent for publication
Moya A, Sutton R, Ammirati A et al (2009) Guidelines for the diagnosis and management of syncope (version 2009). The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS). Eur Heart J 30:2631–2671
Ganzeboom KS, Colman N, Reitsma JB et al (2003) Prevalence and triggers of syncope in medical students. Am J Cardiol 91:1006–1008
Sheldon RS, Sheldon AG, Connolly SJ et al (2006) Age of first faint in patients with vasovagal syncope. J Cardiovasc Electrophysiol 17:49–54
Wieling W, Thijs RD, van Dijk N et al (2009) Symptoms and signs of syncope: a review of the link between physiology and clinical clues. Brain 132:2630–2642
Thijs RD, van den Aardweg JG, Reijntjes RH et al (2008) Contrasting effects of isocapnic and hypocapnic hyperventilation on orthostatic circulatory control. J Appl Physiol 105:1069–1075
Edholm OG (1952) Physiological changes during fainting. In: Wolstenholme GEW (ed) Visceral circulation. Churchill, London, pp 256–267
Blount SG (1971) Cyanosis: pathophysiology and differential diagnosis. Prog Cardiovasc Dis 13:595–605
van DiJk JG, Thijs RD, van Zwet E et al (2014) The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes. Brain 137:576–585
Alboni P, Brignole M, Menozzi C et al (2001) Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol 37:1921–1928
Alboni P, Brignole M, Menozzi C et al (2004) Clinical spectrum of neurally mediated reflex syncope. Europace 6:55–62
Khadilkar SV, Yadav RS, Jagiasi KA (2013) Are syncopes in sitting and supine positions different? Body positions and syncope: a study of 111 patients. Neurol India 61:239–243
Benejelloun H, Birouk N, Slaoui I et al (2005) Autonomic profile of patients with migraine. Neurophysiol Clin 35:127–134
Piovesan EJ, Sobreira CF, Scola RH et al (2008) Episodic migraine associated with postural orthostatic tachycardia and vasovagal syncope. Arq Neuropsiquiatr 66:77–79
Thijs RD, Kruit MC, van Buchem MA (2006) Syncope in migraine: the population-based CAMERA study. Neurology 66:1034–1037
Valleio M, Martinez-Martinez LA, Grijalva-Quijada S et al (2014) Frequency of migraine in patients with vasovagal syncope. Int J Cardiol 171:e14–e15
Hamilton JG (1995) Needle-phobia: a neglected diagnosis. J Fam Pract 41:169–177
Bienvenu OJ, Eaton WW (1998) The epidemiology of blood-injection-injury phobia. Psychol Med 28:1129–1136
Ost LG (1992) Blood and injection phobia: background and cognitive, physiological, and behavioural variables. J Abnorm Psychol 101:68–74
Newman BH (2002) Vasovagal reactions in high school students: findings relative to race, risk factor synergism, female sex, and non-high school participants. Transfusion 42:1557–1560
Singh IM, Antoun PS, Baugh L (2008) Cardioinhibitory syncope due to bloodphobia associated asystole. Int J Cardiol 130:e47–e49
Deacon B, Abramowitz J (2006) Fear of needles and vasovagal reactions among phlebotomy patients. Anxiety Disord 20:946–960
Meade MA, France CR, Peterson LM (1996) Predicting vasovagal reactions in volunteer blood donors. J Psychosom Res 40:495–501
Accurso V, Winnicki M, Shamsuzzaman AS (2001) Predisposition to vasovagal syncope in subjects with blood/injury phobia. Circulation 104:903–907
Graham LA, Kenny RA (2001) Clinical characteristics of patients with vasovagal reactions presenting as unexplained syncope. Europace 3:141–146
Sutton R (1996) Vasovagal syncope: clinical features, epidemiology and natural history. In: Blanc JJ, Benditt DG, Sutton R (eds) Neurally mediated syncope: pathophysiology, investigations and treatment. Futura Publishing Company, Armonk, pp 71–76
Ungar A, Sgobino P, Russo V et al (2013) Diagnosis of neurally mediated syncope at initial evaluation and with tilt table testing compared with that revealed by prolonged ECG monitoring. An analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3). Heart 99:1825–1831
Sutton R, Brignole M (2014) Twenty-eight years of research permit reinterpretation of tilt-testing: hypotensive susceptibility rather than diagnosis. Eur Heart J. doi:10.1093/eurheartj/ehu255
Calkins H, Seifert M, Morady F (1995) Clinical presentation and long-term follow-up of athletes with exercise-induced vasodepressor syncope. Am Heart J 129:1159–1164
Sakaguchi S, Shultz JJ, Remole SC et al (1995) Syncope associated with exercise, a manifestation of neurally mediated syncope. Am J Cardiol 75:476–481
Kosinski D, Grubb BP, Karas BJ et al (2000) Exercise-induced neurocardiogenic syncope. Clinical data, pathophysiological aspects and potential role of tilt testing. Europace 2:77–82
Colivicchi F, Ammirati F, Santini M (2004) Epidemiology and prognostic implications of syncope in young competing athletes. Eur Heart J 25:1749–1753
Romme JJ, van Dijk N, Boer KR et al (2008) Influence of age and gender on the occurrence and presentation of reflex syncope. Clin Auton Res 18:127–133
Wise EA, Price DD, Myers CD et al (2002) Gender role expectations of pain: relationship to experimental pain perception. Pain 3:335–342
Miller C, Newton SE (2006) Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization. Pain Manag Nurs 4:148–152
Parry SW, Kenny RA (2001) The role of tilt table testing in neurocardiovascular instability in older adults. Eur Heart J 22:370–372
Del Rosso A, Alboni P, Brignole M et al (2005) Relation of clinical presentation of syncope to the age of patients. Am J Cardiol 96:1431–1435
Tan MP, Parry SW (2008) Vasovagal syncope in the older patient. J Am Coll Cardiol 51:599–606
Pfeifer MA, Weinberg CR, Cook D et al (1983) Differential changes of autonomic nervous system with age in man. Am J Med 75:249–258
Rowe JW, Troen BR (1980) Sympathetic nervous system and aging in man. Endocr Rev 1:167–169
Mathias CJ, Deguchi K, Bleasdale-Barr K et al (1983) Frequency of family history in vasovagal syncope. Lancet 352:33–34
Camfield PR, Camfield CS (1990) Syncope in childhood: a case-control clinical study of the familial tendency to faint. Can J Neurol Sci 17:306–308
Newton JL, Kerr S, Pairman J et al (2005) Familial neurocardiogenic (vasovagal) syncope. Am J Med Genet A 133:176–179
Mathias CJ, Deguchi K, Bleasdale-Barr K et al (2000) Familial vasovagal and pseudosyncope: observations in a case with both natural and adopted siblings. Clin Auton Res 10:43–45
Marquez MF, Urias KI, Hermosillo AG et al (2005) Familial vasovagal syncope. Europace 7:472–474
Serletis A, Rose S, Sheldon AG et al (2006) Vasovagal syncope in medical students and their first-degree relatives. Eur Heart J 27:1965–1970
Krediet CTP, Jardine DL, Cortelli P et al (2004) Vasovagal syncope interrupting sleep? Heart 90:e25
Jardine DL, Krediet CPT, Cortelli P et al (2006) Fainting in your sleep? Clin Auton Res 16:76–78
Busweiler L, Jardine DL, Frampton CM et al (2010) Sleep syncope: important clinical associations with phobia and vagotonia. Sleep Med 11:929–933
Hu K, Scheer FAJL, Laker M et al (2011) Endogenous circadian rhythm in vasovagal response to head-up tilt. Circulation 123:961–970
Richardson DA, Bexton RS, Shaw FE et al (1997) Prevalence of cardioinhibitory carotid sinus hypersensitivity in patients 50 years or over presenting to the accident and emergency department with unexplained or recurrent falls. Pacing Clin Electrophysiol 20:820–823
Kenny RA, Richardson DA (2001) Carotid sinus syndrome and falls in older adults. Am J Geriatr Cardiol 10:97–99
Shaw FE, Kenny RA (1997) The overlap between syncope and falls in the elderly. Postgrad Med J 73:635–639
Alboni P, Coppola P, Stucci N et al (2014) Differential diagnosis between unexplained fall and syncopal fall: a difficult or impossible task. J Cardiovasc Med. doi:10.2459/JCM.0000000000000076
O’Dwyer C, Bennett K, Langan Y et al (2011) Amnesia for loss of consciousness is common in vasovagal syncope. Europace 13:1040–1045
Parry SW, Steen N, Baptist M et al (2005) Amnesia for loss of consciousness in carotid sinus syndrome. Implications for presentation with falls. J Am Coll Cardiol 45:1840–1843
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Alboni, P., Dipaola, F., Coppola, P., Furlan, R. (2015). Clinical Presentation and Diagnosis of Vasovagal Syncope. In: Alboni, P., Furlan, R. (eds) Vasovagal Syncope. Springer, Cham. https://doi.org/10.1007/978-3-319-09102-0_11
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DOI: https://doi.org/10.1007/978-3-319-09102-0_11
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