Talk:Reflex syncope

Personal histories not generally helpful ("Not a Discussion Forum")

Just a reminder, the talk page is not a discussion forum for sharing your personal stories. Please refrain from filling it up with your own detailed medical histories or experiences. While they may be relevant, they are only anecdotal, and Wikipedia requires verifiable information from recognized, published sources such as medical journals, clinical studies, and so on. If you have some knowledge of the subject through something your doctor told you for example, please try to find a published citation that supports that information. Detailed information about your medical history (your age, weight, medications, type and frequency of symptoms, triggers, treatments, how long or how often you have been ill, personal theories of the disease, what happened to you last month, etc.) are, as a general principle, not relevant to the goal of writing an encyclopedia article on the subject. Thanks for your understanding! IamNotU (talk) 11:26, 13 August 2013 (UTC)

Causes incorrect

The causes listed in this section, according to the citation, are related to the more general "vasomotor syncope" rather than "vasovagal syncope" as indicated. For example, P.O.T.S., orthostatic hypotension, low blood sugar, etc., are separate causes of syncope (fainting) in general. I don't think any of those can be said to be causes of *vasovagal* syncope, which is itself a separate cause of syncope. Comments? IamNotU (talk) 12:38, 13 August 2013 (UTC)

I agree. Also, there's no specific mention of nor link with Hypervagaltonia and Sinus node dysfunction / Sick sinus syndrome. Thank you, Wordreader (talk) 14:19, 25 July 2014 (UTC)

Expansion of page + Link to Chronic Fatigue Syndrome

Need more on the Heredity issue - my mother and one aunt have this , as does one daughter. Mare148 (talk) 16:52, 10 July 2012 (UTC)

fwiw, I think it deserves its own page, separate from Vagus Response, because people who come looking for the info may not be aware of the connection. "See Also" is the right kind of connection, I think, between the pages. — Preceding unsigned comment added by 67.252.9.145 (talk) 15:14, 13 August 2011 (UTC)

If anyone wants to assist, I think this page could use some upkeep and expansion. As it stands right now this page is somewhat messy and missing some highly relevant information.

Here is a link to a highly informative online article on Orthostatic intolerance, in particular Neurally Mediated Hypotension (NMH, aka neurocardiogenic syncope), the condition most associated with vasovagal syncope.

This article needs more clarification of its connection to conditions such as NMH and to orthostatic intolerance in general.

Also, the treatment section should be updated, such as to mention the importance of increased salt and water consumption in fending off syncopal episodes.

Another topic worth mentioning, is the link between NMH (which can manifest as vasovagal syncope) and Chronic Fatigue Syndrome (CFS). This link is well documented in several peer reviewed journal articles (citations can be found here). It is also mentioned in an informative emedicine.com article on orthostatic intolerance, which will be valuable for updating this article (along with the wikipedia article on Orthostatic Intolerance). Here are a few other links discussing the connection between NMH (or vasovagal syncope) and CFS: [1] [2].

So, I propose that changes to this page and the Orthostatic Intolerance page should be made and be coordinated. Furthermore, these pages should be expanded and organized to give a clear definition of the relation of vaso-vagal syncope to conditions of orthostatic intolerance, to include the name(s) of the conditions which are associated with vaso-vagal syncope, and to include more information on treatment and the link to CFS.

One other question is whether these conditions should still be subsumed under the article vaso-vagal syncope, considering that vaso-vagal syncope is generally caused by the condition neurally mediated hypotension, yet NMH does not always result in syncope.

-- 19:59, 9 November 2006 (UTC)

I'm removing the following sentence: "It is worth noting that on rare occasions, a fainter may die if forced to remain upright." Does anyone have a citation or study for this outcome? — Knowledge Seeker দ 06:03, 19 Apr 2005 (UTC)

As a sufferer i was given that exact advice from my doctor, if i am not allowed to sit or fall during a fit the blood loss to the brain can be fatal. --Seth Turner 10:44, 3 February 2006 (UTC)

I am also chronic sufferer (I "black out" from an episode 5-10 times a week). While being diagnosed, my cardiologist instructed me to lay down in order for my body to restore blood-flow, but when I black out these days (My condition showed itself when I was 5, I am now 19), if it is not practical to lay down, I don't. I can remain upright for a black-out via learned a learned behavior ("rocking" in a circular motion while standing). I haven't noticed anything negative about this, although I am not a medical doctor. I can't rule out the mentioned "rare occasions" though.--SirGrok 07:52, 12 April 2007 (UTC)

• Wow, I can't believe that I haven't looked at this talk page before now, or I would have answered this a long time ago. I have vasovagal syncope and I was told that by my former doctor (though I wasn't the one who originally put that in the article). The idea is, if there's low blood pressure and what little blood volume there is is pooling in the legs, then that means there won't be enough blood in the brain, and the brain will become starved for oxygen and other nutrients. Jacqui ^★ 04:08, 10 November 2005 (UTC)

There does not need to be a study of death by inappropriate treatment documented many thousands of years ago and regrettably in more than one coroners report.

Actualy its more like seeing static than blurry vision. Like the snow screen you get when your telivision isnt tuned in. Baiscaly for me its total blindness during the syncope.--Seth Turner 10:44, 3 February 2006 (UTC)

There does need to be a citation for a comment like that. It doesn't have to be a randomized clinical trial. It could be a reference from a medical textbook. I personally think there is far more danger from being allowed to fall down and hit your head on the pavement. Yes, your blood pressure drops during vasovagal syncope, and yes, you should gently lie the patient down to a supine position. But death? From holding a vasovagal syncope upright? Sounds like mythology to me, but I'm willing to be proven wrong. MoodyGroove 19:29, 25 January 2007 (UTC)MoodyGroove

You're looking for Suspension trauma -- Falling down increases blood flow to the brain. If the person remains upright -- usually because they are trapped in a harness -- they may not be able to restore blood flow to the brain, and they could die. Moving your legs causes a pumping action that prevents blood from pooling in the legs. --Mdwyer 16:54, 10 April 2007 (UTC)

I am 53 years old and reasonably fit non smoker etc. I was recently diagnosed with vasovagal syncope brought on by dehydration amongst other things. During Tilt Table Testing my heart stopped for 21 seconds before being revived by medical means. I now have a pacemaker fitted to guarantee a minimal pulse rate of 50 bpm. It operates mostly around 3-4 am when statistically more people die in their sleep (circadien rythm ?). So I now beleive VVS can be a killer. Ian Roberts

--- Only have time to quickly note a slightly different situation described by Ian (heart stopping) vs. the above discussion re: 'dying from remaining upright' during vasovagal response. I only mention it because your heart stopping is clearly rather bad for you (I have had this happen to patients from vagal response to peritoneal stretching; other classics are eye surgery etc), whereas the poor perfusion while upright is in somewhat of a different range of urgency! I wish I had time to search for data, but - if it helps - it appears to be somewhat counter-intuitive to be able to keep oneself upright for long enough to cause death, despite proprioception etc being controlled at a low/basic level. Whilst I would imagine nothing is impossible, I could only think that one would have to be kept passively upright (a harness was mentioned, although these typically seem to keep one in a semi-crouched position, and the head would drop) to force a situation resembling the described danger. The crucial difference would be that normally there is a slight delay between a sudden blood pressure change (standing quickly, vagal storm or whatever), and the baroceptors noticing & feeding back instructions to increase perfusion via increased stroke volume, higher heart rate, increased peripheral resistance etc; a very brief delay is not uncommon in everyday people (sometimes perceptible), whereas people with such a propensity might have a longer delay (slower restoration of perfusion). This is still a delay however (otherwise you would expire; you would never be able to stand under any circumstances), although it may cause temporary loss of consciousness. The difference in the proposition of death by remaining upright, is that there is no temporary relief during this intervening period of poor perfusion, by your head (and body) falling to a lower level (syncope); however, one would also have to assume that the expected response (physiological restoration of blood pressure) would somehow either then be absent, or that the delay was extremely long (cerebral ischaemia causing permanent damage typically reported as e.g. 3 minutes onward). Much like aviation, one could postulate that several problems might well have to occur simultaneously for this to have any likelihood of an effect! (i.e. when one considers serious co-morbities, then any cause of a transient hypotension might have a knock-on effect - or a slower return to homeostasis). As a separate issue, complete asystole - as described by Ian Roberts - is incompatible with life, and being in any position including (passively!) upright, upside down or whatever is irrelevant to your blood, which would be static! Returning to the proposed mechanism, however, when one considers the risks from simply falling during syncope - which are very real - the possiblity of being able to remain upright and then have no physiological response to a critical lack of perfusion seems very remote. Having said that - as any infant intuitively knows - it is clearly good common sense to sit or lie immediately when one feels faint (for any reason)!

Stepping outside of scientific consideration, the idea of dying whilst standing upright (for this reason) sounds suspiciously like an urban myth; however, I don't want to dismiss something out of hand without any evidence! By that same measure, to include such a proposal in Wikipedia (which informs both the general public, and is even 'trusted' by some healthcare students nowadays) is an exceptional claim, and would require very clear (i.e. exceptional) evidence, lest we simply spread 'what we heard somewhere' into an internet 'what I read somewhere'.... This, of course, is entirely separate from the rather obvious advice to not remain standing when you feel faint!

Please don't interpret this as a medical opinion - I am not qualified, allowed, nor would be able to give such advice even if I was silly enough to try! If you suffer from a related problem, talk to your doctor about your concerns; hopefully they will be as interested in the idea as I am! Shane Wilde (clinician & medical student).

Perhaps we should include some information about Suspension trauma in this article, then. Would you like to add it? WhatamIdoing (talk) 23:21, 12 March 2009 (UTC)

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I've had VVS for about 20 years (will be 33 in 28 days or so) normal mild episodes occur after kneeling of sitting cross-legged then standing quickly and happen for about 2-5 seconds (feels like 2-5 minutes). I recently had 2 very bad episodes with total blackouts taking 15 - 20 minutes to recover from and lasting between 2 and 5 minutes before recovery starts). I broke my leg 3 months ago and have been spending most of my time lying down since then. I have just started doing workouts with weight machines at my Physical Therapist appointments an two visits in a row I completely blacked out. The episodes start with a tightness in the chest, similar to a heart attack, as the heart starts having problems pumping the blood around the body (pooling in the legs, which I also have large quantities of varicose veins around my ankles), then you start to feel like you aren't breathing even though you are (similar to an asthma attack), followed by light-headedness. At this point it is like the really old CRT TV's and Monitors, everything starts to look like the snow on the tv (I never thought of it like that till I read this page), kind of speckled between what is real and darkness and like the computer monitor, it slowly fades out into darkness in a pulsing manner (with your heart beat, where after each beat it is brighter, then fades further in to darkness right after). If I am still standing at this point I start to fall over (similar to falling asleep in school, when your head starts nodding), most times this is enough to drive my consciousness to try and force my body to "wake up" giving me a brief second or 1.5 seconds of cognition to attempt to lay down or find support to lean on before it is lights out. My PT suggested that I might have VVS an has directed me to a neurologist and a cardiologist to check for VVS and Orthostatic Hypotension. She said that what occurs is with my increased heart rate and decreased blood pressure that the valves in my veins are either not constricting completely or are not reacting fast enough and the blood follows gravity with more efficiency than the valves are able to counter-act. I had not heard of it before, but had been having this happen, as I mentioned above, for about 20 years maybe longer, I used to think it was cool and would do it on purpose to freak people out, or while alone because I thought it felt "neat", no I never did drugs and I drink about 2-4 beers ever 3-8 months; although I drank massive amounts of whiskey for 3.5 years while in college. I hope this helps, might want to check with some cardio and neural specialists on this, or even some physical therapists, 3 of the PTs in the office I was at were familiar with OSH and its symptoms and treatments and one had familiarity with VVS. (Finndo (talk) 13:48, 16 April 2010 (UTC))

Ginger Ale?

How would ginger ale help? I haven't done any research outside of reading that line, but as far as I know, modern day ginger ale is no different from any other soda in terms of ingredients.

That entire line seems somewhat spurious, regardless, as the end of the sentence directly before it clearly mentions increasing fluid and salt intake. Plus there's a comma splice! Yuck. I'll clean it up a bit. - Zowch 09:02, 28 May 2006 (UTC)

When I was on active treatment, I was ordered to drink .5 gallons of Gatorade (or any other electrolyte heavy fluid a day). This was for the sodium and the electrolytes. I was also taking 1gm of sodium by tablet a day (in addition to eating a salt heavy diet) and Flourinef (I do not remember the dosage... I was probably 100 lbs at the time of the treatment). I have never heard about ginger ale being a home-remedy. --SirGrok 19:26, 30 May 2007 (UTC)

New Comment: 67.231.168.88 (talk) 11:40, 10 November 2011 (UTC)10Nov11 rviewer@prtcnet.com I have not personally tried ginger ale, but I can see the logic. The soothing effects of ginger ale on the digestive tract make sense. I have apparently been experiencing this vagus nerve distress since August 2000, for a long while not understanding the phenomena or its triggers. However, I have observed that certain ingested irritants increase the likelihood of the "attacks" --only some of which lead to syncope. Among the irritants are food coloring prevalent in many flavored drink mixes, swallowing toothpaste, and (of course) the dehydration, stress, and sleep deprivation already mentioned in the article. In my case, the symptoms are consistent --almost orgasm-like feeling of queasiness, flushing, and imminent threat that I might either "throw up or pass out"-- which lasts ~ 2 minutes. Once a single attack has occurred, it is almost always followed by more attacks within a 2-5 day period --presumably because it takes that amount of time for intestinal irritation to subside. My responses are to assume a head-down position in any safe way I can or to immediately tense abdomen and legs (G-suit response --forcing blood back into the upper body) if driving a motor vehicle. Additionally, once an attack has begun, it is usually a very bad idea to introduce any new gastro-intestinal stimulants (like taking a sip of a cold drink, for example) as they might overstimulate the nerves and result in fainting. From personal observation, there are generally two triggers: either some kind of bowel activity or a large amount of warm water or air passing over the top of my head.

Contradiction??

"Vasovagal syncope (also vasodepressor syncope ...[truncated]... It is important to realize that vasovagal syncope and vasodepressor syncope are NOT the same." (Quoted from the version on 8/10/2006.)

This is a contradiction. Either vasovagal syncope is also known as vasodepressor syncope or they are not the same. Someone with medical expertise, please clairfy. Jxyama 17:37, 10 August 2006 (UTC)

Yeah, that looks like a mess. I am not a doctor; I have the condition. None of my doctors have used the term vasodepressor syncope on me, though. Nevertheless, a quick look at the web in Google shows a few places where the terms appear to be used interchangably: This one includes two more names for the condition? This one lists a cause I've never heard of?

LIS, I'm not a doctor, and frankly I know this diagnosis is somewhat controversial. It was only "discovered" five to ten years back and I think they are still working out what is and isn't part of this diagnosis. Anyway, I'm going to add the expert tag and do nothing else for now. Jacqui^★ 13:44, 19 August 2006 (UTC)

Just a touch of input. I have Vasodepressor Syncope, as was directly diagnosed, and a few things seem to be quite different between that and the vasovagal condition described above. In my case (I was told it is a typical case)The heartrate skyrockets(upwards of 200 bpm at rest) and bloodpressure drops(somewhere into the low 20's). This results in a pooling of blood in the feet, and a lack of blood in the brain. As far as I understand, VDS is actually heart-initiated, where VVS is initiated by a lack of blood in the core of the body. Same results, different reasons. Understand that this is simply an explanation from one doctor to a patient, and conformation would be reccomended. -Jason

Note: the IP address that added the disputed section has many vandalization messages on its talk page. Nevertheless, IPs can be shared by many people and so we should still look into this carefully. Jacqui^★ 13:49, 19 August 2006 (UTC)

Vasovagal syncope, vasodepressor syncope, neurocardiogenic syncope, and situational syncope all refer to the same form of syncope.(http://www.medterms.com/script/main/art.asp?articlekey=7713) I believe neurally-mediate syncope is also synonymous.

—Preceding unsigned comment added by 222.124.68.252 (talk) 05:32, 2 October 2007 (UTC)

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Prognosis

I removed from the article the sentance, "It may also be associated with certain psychiactric disorders." There's no citation for this. Is this true? And if it is, what psychiatric disorders are associated? --Brokenchairs (talk) 14:56, 19 January 2008 (UTC)

Last time i was told by ER techs, it can be caused by Anxiety 172.189.6.182 (talk) 07:29, 29 January 2008 (UTC)

I was just diagnosed with vvs today, for me these episodes occur only when I smoke pot. I do not think that the cause of these episodes are due directly from this drug but during the time, my consiousness is altered as anyone who smokes should know, and I become super sensitive to things. The first two times it happened i was in the shower and it was really steamy in the room and i felt like i was suffocating..the other time i was watching pulp fiction and got really anxious due to the scenes in the movie. My fainting episodes usuallys start with me feeling dizzy and overwhelmed becuase I feel like i can't breathe. Then things become blurry and I "fade" out and then I pass out. My doc told me to just make sure I lie down when I feel the oncoming of any episode and to increase blood circ. to my brain. Also, I am a stylist so I am on my feet all day, and then I exercise 5 days a week after work...but although I consider myself pretty healthy, I know that I do not drink enough water and I do smoke cigarettes which causes dehydration, and with the addition of pot... I think that it is the ultimate dehydration and THAT is why I have my episodes. Does anyone know anything about marijauna users and vvs?BAM721 (talk) 16:45, 11 March 2008 (UTC)BAM721

Being complicated

Instead of saying 'sayone faints', would 'someone Vasovagal syncopes' make sense just to be complicated to people? 86.135.42.213 (talk) 14:48, 20 April 2008 (UTC)

Triggers

I have always been a sufferer of vasovagal syncope, triggered by medical procedures. Most often, it is receiving injections.. I'll be fine during the injection, but within 5 minutes I lose blood pressure and start feeling very queasy, to the point of fainting. Sometimes, it takes merely thinking about medical procedures to trigger the effect. Once, I was at a friend's apartment and he was flipping through TV channels, and came across a liposuction procedure on Discovery.. Very harsh and painful looking procedure, it makes me feel uncomfortable even thinking about it as I type this.. But I had to ask him to change the channel because I felt like I was going to faint. ..My point is, this is my personal experience based anecdotal citation for adding the "viewing/experiencing medical procedures" to the Triggers section. Weasel5i2 (talk) 08:53, 5 May 2008 (UTC)

I suffer from vasovagal syncope during injections as well. Last night, I suffered one after watching a very realistic dramatization of phlebectomy. I have no problem watching extremely gory and violent films, but in this case, because the situation was made to be as realistic and matter-of-fact as possible, it brought back memories of being hospitalized during the influenza outbreak of 1962 (at the age of 2), and down I went.

I don't see a reference to alcohol as either a trigger or at least a contributor. I am an occasional sufferer and when I discussed it with my doctor he immediately asked about alcohol consumption, which was a common factor in my case, and said that it was a "usual" factor (his term) in a vasovagal episode. If anyone can cite this I suggest it would be a useful addition. Delverie (talk) 18:10, 26 July 2009 (UTC)

Including the mammalian diving reflex hyperlink as a potential cause is wrong. the mammalian diving reflex causes bradycardia and vasoconstriction, whereas vasovagal syncope causes bradycardia and vasodilation. I'm not going to remove it, because I lack the authority. 22/05/2011 —Preceding unsigned comment added by 87.113.215.177 (talk) 22:07, 22 May 2011 (UTC)

Beta blockers

Are beta blockers still used for Postural orthostatic tachycardia syndrome, which also involves vasovagal syncope? WhatamIdoing (talk) 17:01, 28 July 2008 (UTC)

New source

The British Medical Journal has a good overview (free) on this topic here. It might be useful for cleaning up some of this article and/or sourcing some of the parts that already exist and are correct. WhatamIdoing (talk) 04:47, 3 February 2009 (UTC)

Vasodepressor syncope management by sufferer

Nellbednarz (talk) 16:18, 8 January 2010 (UTC) I am in my 50s and have suffered with vasodepressor syncope all my life. I was misdiagnosed with hypoglycemia in 1981 and lived on a no-sugar diet for many years. That did help, because sugar acidifies the blood and makes calcium dump out of your system (as does caffeine, phosphoric acid from soft drinks, and hyper-ventilating since too much O2 acidifies the blood), and causes blood to pool in the legs. My daughter began showing symptoms while in elementary school, sometimes being so severe that we thought she was having a heart attack. The doctor that diagnosed her from her symptoms was the head of pediatric cardiology in Texas Children's Hospital in Houston, Tx. While he was explaining that this is a disorder that is congenital (genetic) and tied to mitral valve prolapse, my daughter turned to me and said "This is what makes you so faint sometimes".

I was diagnosed by a Tilt Table Test at Houston Arrythmia Center in 2006, with a textbook reaction and fainting. My blood pressure soared to 160/100, triggering a delayed but profound reaction of my brain telling the adrenal glands to dump a lot of adrenal to lower the blood pressure, which caused the blood pressure to drop so low that it could not be measured. Those of us with this disorder often have problems with anxiety because we are pumping a lot of adrenaline on a daily basis. This can lead to adrenal exhaustion.

Vasovagal syncope can happen to almost anyone, vasodepressor syncope happens in families and is usually life-long, since it is linked to the gene that causes mitral valve prolapse (according to Dr. Timothy Bricker). Years ago, I concentrated on how I could help my daughter have a more normal life. She was struggling to have enough energy to make it through a day at school (the dehydration capital of the world). It seemed that calcium/electrolyte dumping was a major problem for both of us, resulting in extreme hot flashes then diarrhea. The trigger was usually food-related, and we found that eating sugar or having caffeine from chocolate or coffee was the common cause. Drinking 1/2 of a coffee-based drink put my daughter in the hospital ER, and she was told never ever to have coffee or caffeine. Our medical bill for that episode is still very convincing. Caffeine causes blood to pool in the legs, as does sugar, starving the heart, which will exert a lot of pressure on your right arm to get more blood. It hurts to the point of disabling you.

As a trained scientist, I naturally wanted to find answers for our sudden fatique problems. In digging to find a way to stabilize the calcium in our systems, I read Dr. Robert Atkins "Vita-Nutrient Solution" about how different nutrients work, usually needing a balance to keep us healthy. Vasodepressor syncope is not discussed in that book, but the balance of electrolytes (which is crucial in our living healthy lives) is covered very well. The amino acids are covered, and while reading about the functions of taurine, I made an important discovery.

Taurine is not the muscle-building type of amino acid; it primarily functions in maintaining calcium, magnesium and other electrolytes where they belong, rather than letting the minerals go where they do not belong. Taurine stabilizes pressure in the eye, controls the viscosity of bile and other fluids, and even acts as a diuretic only if you have too much water in your body compared to electrolytes.

I decided that we would try using taurine to keep our calcium from dumping. In the years since my discovery (2006), practice has taught me this -- I need to take 1000 mg. of taurine with each meal and before exercise about 3000 mg per day but can go up to 5000 mg/day in 1000 mg doses), as well as massive supplementation of magnesium, calcium, zinc, manganese, and other minerals, keeping proportions balanced. This is therapeutic doses as described by Dr. Atkins. Magnesium is often the limiting factor. Without enough magnesium, you will feel chronically dehydrated and suffer muscle cramps.

Supplementation of the B vitamin complex is also essential to dampen the anxiety response. I find that I need sublingual B-12 every day to keep up my energy, and that B-12 pills only give you 2% of the vitamin whereas sublingual (under-the-tongue application held 30 seconds) gives you about 98% of the vitamin. I learned that anything with too much sugar caused problems, including Gatorade, so my practice is to carry salt packets with me in case of a major muscle cramp (especially the heart or lungs) and drink plenty of water. To balance the potassium and sodium intake, it is important to use "salt substitute" (potassium salts) on food, which gives about 17% of the daily need.

Avoiding sugar can be a struggle, and sugar substitutes can cause bowel problems. Fructose seems to be tolerated better and not cause so much calcium dumping, but my current favorite sweetener is Stevia (Truvia is a current brand). Recipes for stevia can be found online. Bananas and grapes have too much sugar, but berries and low-sugar fruits are the ideal dessert.

I give this advice as a sufferer of vasodepressor syncope, not as an MD. I have found that most doctors don't know much about this disorder, and I have been my own guinea pig. Before I began working out this nutrient thing, I would have such severe muscle cramps that I would be bedridden for days. Now I rarely ever have to do more than rest with my feet up. The blood vessels in my legs don't break nearly as much as they once did and life is much more normal, but I still eat often (every 2 hours or so a small healthy snack like nuts), drink plenty of water all day, stay away from heat or heavy excerise, walk every day if possible (walking pumps the blood back to the heart), and take my nutrients throughout the day at meals, according to what is balanced. A doctor or nutritionist would help with this.

Of course, I try to stay calm and learned bio-feedback to help me with chronic anxiety. As a Believer in the Lord, I have found that turning my worries over to Him helps me stay focused and steady.

Please take time to have yourself tested with the Tilt Table Test, and have guidance in what you do. Taurine naturally lowers the blood pressure, so testing BP at waking will let you know if you really need blood pressure meds or not. Always tell your doctor if you are taking supplements to lower blood pressure. From NB in Texas Nellbednarz (talk) 16:18, 8 January 2010 (UTC)

Need an expert in Wiki syntax to fix References problem

I could not figure out how to fix: References

  1. ^ vasovagal attack      
     at Dorland's Medical Dictionary will not affect my baby girl kaitlin.

I searched for "kaitlin" in the edit view of the page, and nothing came up. I'm sorry I can't do more, but I'm chronically ill so most days I can only do quick fixes, meaning sometimes I can only point out the problem and hope someone else will fix it. Thanks! —Preceding unsigned comment added by Geekdiva (talk • contribs) 05:01, 29 March 2010 (UTC)

no "will not affect my baby girl kaitlin" nonsense in currentversion - suggest refresh your page view. David Ruben ^Talk 20:40, 4 April 2010 (UTC)

Merge vagus reflex

Vagus reflex currently covers same topic and is a mere stub to this article, listing just a limited selection of causes. David Ruben ^Talk 20:37, 4 April 2010 (UTC)

Rename to vasovagal response

The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the move request was: page moved.  Ronhjones  ^(Talk) 01:02, 13 April 2010 (UTC)

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Vasovagal episode → Vasovagal response — PubMed for "Vasovagal episode" =23 articles,"Vasovagal response" =64, "vasovagal attack" =18.

This article is on the physiological process, rather than being the extreme of fainting that may not occur. Hence "neurocardiogenic syncope" with 355 PubMed articles, is not an appropriate name (would be akin calling [neck sprain] by term [decapitation]). Likewise ICD10 code of R77 points to "Syncope and collapse" which is too general a process, of which this is but one cause.

Therefore, on basis of WP:MEDMOS "The article title should be the scientific or recognised medical name that is most commonly used...", I propose rename article to "Vasovagal response". David Ruben ^Talk 21:08, 4 April 2010 (UTC)

The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

aftermath/resolution

The article needs detailed and extensive information about immediate and lingering after-effects. What is the mechanism of recovery from vvr? What makes it faster or slower? How long can there be subtle after-effects (such as lower than normal heartrate): hours? days? weeks? -71.174.188.137 (talk) 03:38, 11 May 2010 (UTC)

Treatment Drugs

I am a 61-year-old man. I suffered my first episode of Vasovagal Syncope at age 4 or 5 when I cut my fingers playing with some discarded razor blades. My triggers continue to be blood related, including injections and blood draws, but it has also been triggered by painful injuries and most recently by food poisoning. When I was 33 years old a heart doctor threatened to install a pacemaker to remedy the problem. As an alternative he offered a prescription for an anticholinergic drug, Darbid. This is basically an ulcer medication. The drug worked, and I was episode free for many years. Darbid became unavailable and I was switched to Robinul Forte. Eventually I became accustomed to the stimuli and I did not need the drug. However, after being episode free without the drugs for about 8 or 9 years, I had another episode as a result of food poisoning. I now take the Robinul Forte again. My purpose in sharing this is to suggest to others, and the medical community, that perhaps anticholinergic drugs can help this problem for others without any significant side effects. 98.189.27.157 (talk) 21:25, 4 November 2010 (UTC)

Oral Theophyilline is also used in cases where the causative factor is hypervagaltonia. See the abstract at PubMed and follow link to full, free article:

"Clinical characteristics of hypervagotonic sinus node dysfunction", Korean J Intern Med. 2004 Sep;19(3):155-9, http://www.ncbi.nlm.nih.gov/pubmed/15481606

Thank you, Wordreader (talk) 14:35, 25 July 2014 (UTC)

Vasovagal response

My experienece of such a reaction was the result of post-prsndial hypotension. When eating or having eaten a substantial meal, especially in a hot room, i.e. when post-prandial (after a meal) blood pressure can drop substantially (hypotension)because blood flow falls to the stomach area to help digestion. Which reduces blood to the brain so you faint. The quicker you lie flat or, better, have your feet above your head height the quicker blood gets back to your brain and the quicker you recover. — Preceding unsigned comment added by 213.105.3.199 (talk) 11:35, 29 December 2011 (UTC)

Yes. Raising feet above head has worked well for me.

I don't know if 'Vasovagal response' explains my previous passing out incidents, but it seems to fit.

I've also noticed feeling faint while cycling home late in the evening, after eating out. It's a feeling like being low on blood sugar. This didn't make sense to me until now. But I realise maybe my brain is low on oxygen because I'm digesting.

-- Harry Wood (talk) 12:36, 2 March 2012 (UTC)

Signs and Symptoms

I think it is worth mentioning that syncope can be accompanied by seizure like behaviors (convulsions and eyes rolling back). This happened to my 9 yr old daughter yesterday and it lasted less than 10 seconds. Of course this was very frightening, but the E.R. doctor said that is was only syncope, (he said "fainting" or "passing out, probably caused the severe pain from her bumping her elbow/funny bone just before it happened) and not a seizure because: 1. She regained consciousness almost immediately after falling (becoming prone allowed her blood pressure to return to normal) 2. She was not groggy or "out of it" after she regained consciousness (it if were an actual seizure her brain would have needed 30-60 minutes to "reset" but she was her usual self immediately) 3. Her EKG was normal __________ source: http://www.medlink.com/medlinkcontent.asp Hbmh (talk) 15:07, 28 March 2012 (UTC)

Genetic?

Hey, I'm just curious, since I didn't see anything definitive in the article, but is this disorder a heritable condition? — Preceding unsigned comment added by 70.247.173.255 (talk) 21:30, 11 May 2012 (UTC)

It is not really a disorder, just a predisposition or hypersensitivity to some trigger. The aetiology of the hypersensitivity is very diverse, certainly you will find cases of inheritance. Richiez (talk) 22:21, 12 May 2012 (UTC)

Yes, http://www.neurology.org/content/79/6/561.abstract, fainting of this form was more common among identical twins than in fraternal pairs. — Preceding unsigned comment added by PaigePhault (talk • contribs) 13:32, 13 November 2012 (UTC)

Evolutionary origin and potential benefits

The page as written is exclusively from a medical perspective and therefore not very useful as an encyclopedia page. I would like to see a more balanced perspective incorporating for example material from http://www.ncbi.nlm.nih.gov/pubmed/18592129 that might explain the origin of this malady - if it is a malady. — Preceding unsigned comment added by PaigePhault (talk • contribs) 13:30, 13 November 2012 (UTC)

Small change

The following line in the opening paragraph, "Vasovagal syncope affects young adults more commonly." should be changed to "Vasovagal syncope more commonly affects young adults." Wisdomthatiswoe (talk) 15:37, 18 June 2013 (UTC)

• Go ahead, do it. You are allowed to. If nobody likes it, it will soon be changed back. Ex nihil ^(talk) 22:23, 19 June 2013 (UTC)

Will do, thank you! Wisdomthatiswoe (talk) 15:08, 8 July 2013 (UTC)

Walking to prevent syncope

This information came from a neighbor who is an occuptional therapist and I have searched the internet to see if anyone else mentions it. Have not found it. The instructionw were not to shuffel wehen walking. Step down hard to send send signals to the brain. The message reaches the brain at abour 200 mph. This works for me and another friend I explained it to. If you feel a bit light headed when rising from a chair then this is a good option to try. It really works for me. Jim R. If you want let me know your thoughts jiranz@cmhregional.com — Preceding unsigned comment added by 216.68.205.2 (talk) 15:04, 27 November 2013 (UTC)

I would use caution with this suggestion. If you are standing and feel like you are about to pass out, walking may not be a wise choice. Immediately lying down might be a far better one. Thank you, Wordreader (talk) 14:40, 25 July 2014 (UTC)

By the way, in your example of arising quickly from a chair can cause orthostatic hypotension, a separate situation from vasovagal response: http://www.webmd.com/heart-disease/tc/fainting-topic-overview Thank you, Wordreader (talk) 17:57, 16 October 2014 (UTC)

There is tension/conflict inherent in treatment of a vasovagal episode in a medical setting. Once the episode is in progress, there is a tendency to react with an over-abundance of caution, holding the patient completely quiet and "safe" until the episode passes. Unfortunately, this can also greatly extend the duration of the episode, delaying recovery... So, tricks such as the above are potentially relevant. What reliable sources are there for safe low-tech ways of hastening recovery from an episode? In old movies, "smelling salts" were a classic treatment -- seems like that kind of thing deserves a mention in the article. -96.233.20.129 (talk) 13:51, 16 October 2014 (UTC)

Since a person in the throws of an episode is extremely lightheaded to the point of unconsciousness (and frequently are unable to think clearly), I strongly suggest that you do NOT require them "to walk it off". As for using the old "smelling salts" (ammonia, these days), what reference do you have for the efficacy of this technique on the vasovagal response besides "old movies"? Thank you, Wordreader (talk) 17:48, 16 October 2014 (UTC)

I do not advocate any specific treatments, nor make any efficacy claims -- these are matters I would like to learn about! Movies used to often show people (mostly females) fainting, and being treated with smelling salts. These facts deserve mention in relevant articles. Outside of movies, did people commonly faint? Were smelling salts commonly used? Such facts would also be relevant, if well sourced. If ammonia is a current treatment option, that would be worth mentioning, along with information about efficacy and risks. Similarly, if there are other low-tech ways of hastening recovery from an episode it would be appropriate to mention them, with attendant efficacy and risks. -96.233.20.129 (talk) 22:24, 16 October 2014 (UTC)

Readability

My reading comprehension and vocabulary are higher than the norm, but I could barely read this article. Can we tone down the jargon? This isn't a medical textbook. 184.77.68.158 (talk) 05:25, 26 August 2014 (UTC)

I so agree with 184.77.68.158. This article, and most technical/scientific/medical articles on WP that I've read, get top heavy with jargon and minutia on the cellular level. Plain language will increase the article's usability for the casual reader. If readers want to delve deeper, then provide links to jargony terms and/or build up to more complex matter later in the article. Example of a possible change: ". . .is a malaise mediated by the vagus nerve." ---> ". . .is a feeling of unease or dizziness caused by a nerve that originates in the brain, the vagus nerve"? Thank you, Wordreader (talk) 06:16, 10 September 2014 (UTC)

Duration: minutes vs. hours

The article currently says:

 "The autonomic nervous system's physiologic state (see below) leading to 
     loss of consciousness may persist for several minutes, so: 
    If sufferers try to sit or stand when they wake up, they may pass out again 
    The person may be nauseated, pale, and sweaty for several minutes or hours"

This is confusingly vague, and unsourced. My experience is that an episode of of vasovagal response typically lasts 3-15 minutes, but can persist indefinitely, at least a couple hours. What good sources are there for improving this aspect of the article? -96.233.20.129 (talk) 15:01, 19 October 2014 (UTC)

Response to perceived threat

The article itemizes many relevant particular causes that are associated with this reaction, but does not group them in a meaningful way nor mention the underlying commonality. A major cause of this response is a deeply embedded physiological response to a category of perceived (physical) threats.

These are all potential members of this cluster:

• During or post-biopsy procedures.
• Stress directly related to trauma
• Any painful or unpleasant stimuli, such as:
  • Trauma (such as hitting one's funny bone)
  • Watching or experiencing medical procedures (such as Venipuncture or Injection (medicine))
• Sensitivity to pain
• In health care, such as nursing care, digital rectal procedures (e.g., digital disimpaction)
• The sight of blood

The phrase "painful or unpleasant stimuli" is particularly potentially misleading. The flavor is quite different from the concept of a perceived serious "threat". Pain is physical. But this response is triggered not by physical pain per se (within this threat-cluster) but rather by the brain being aware and thinking about ideas (being poked by something sharp, for example). So, a person with this threat-cluster reaction might not react to some severe pain experiences, if they were not perceived as real threats, yet might react to an injection -- even an injection that turned out to be nearly painless -- because the idea of being poked by a needle seems too (life-) threatening. Or again, just hearing people chat about medical procedure horrible experiences could be unbearable, because thinking about such things is too vividly-real-threatening.

The closest the article currently comes to properly wording this aspect is:

 exposure-based exercises with therapists if the trigger is mental or emotional, e.g. sight of blood.

-96.233.20.129 (talk) 16:05, 19 October 2014 (UTC)

Other vasovagal condition ???

A friend of mine, who passed away some time ago, had a condition he called "vasovagal" but it does not sound like the symptoms that this article is describing. His symptoms (as I recall) included heart problems (arythmia I think ?), digestive problems (he never really described these in detail but I would say "indigestion" and "heartburn/angina" would be a layman's description), and occasional sudden fatigue requiring him to rest for a while (which of course may be a side effect of the heart issues). There were other issues too like high blood pressure and some specific pains but its been too long and I don't remember the details. I do remember he was not allowed to undergo anasthesia for surgery without extra precautions. But as far as I know he never had anything like fainting (syncope) events.

• QUESTION 1: Is there a different vasovagal response condition and if so what is that called medically to differentiate from syncope? Could it be this?

I remember he said he had lived with this condition for many decades and had eventually learned that his condition was caused by a botched colonoscopy procedure that damaged ("nicked") the nerve. I know he was tested at a UCLA medical facility some years ago and he had a severe ("near fatal") response to the tilt-table. I also remember he often had to show other doctors his meical report from those tests because many doctors did not believe such a condition existed (apparently it is considered a fantasy illness by some doctors). One doctor went so far as to actually accused him of faking the report but the doctor eventually apologized after calling UCLA and talking with someone there. I was not in the doctor's office when this happened but I remember how mad he was for a couple of days until the doctor called him to say sorry.

• QUESTION 2: Why are doctors so resistant to whatever this condition is?

Searching the web I see several references about the cause-effect relationships between colonoscopy and vasovagal response. I am not a medical person so I do not understand half the stuff I read. See these[3][4] just for starters.

• QUESTION 3: Why is there absolutely no mention of colonoscopy in this article if there is a documented correlation between the two?

Just curious but also maybe this stuff needs to be in the article somehow? especially #3. 104.32.193.6 (talk) 12:16, 8 November 2014 (UTC)

Review

QJM doi:10.1093/qjmed/hcw089 JFW | T@lk 15:31, 29 December 2016 (UTC)

Requested move 30 December 2016

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section.

The result of the move request was: moved as proposed, as there are no objections and the reasons given are valid. (closed by non-admin page mover) Bradv 05:17, 16 January 2017 (UTC)

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Vasovagal response → Vasovagal syncope – Much more usually used name on all searches and ngrams. Pubmed gives 610 results for Vasovagal response and 2,402 for Vasovagal syncope. Also there is a confusing mix of terms on page. Iztwoz (talk) 08:23, 30 December 2016 (UTC) --Relisting. Bradv 15:29, 7 January 2017 (UTC)

• Agree "Vasovagal response" is the worst of any proposed titles, but not all episodes are syncopal in nature - some are pre-syncopal or associated with specific symptoms only. Would there be an alternate and better title that includes these but is better than current? --Tom (LT) (talk) 09:14, 1 January 2017 (UTC)

Can find no definition of vasovagal response on page - Symptoms describe a syncope.The rest of the page is referring to syncope. Related items as pre-syncopal could be included on page. ? --Iztwoz (talk) 09:32, 1 January 2017 (UTC)

Also on the page Syncope (medicine) the section Vasovagal has the main article as Vasovagal syncope.--Iztwoz (talk) 06:31, 13 January 2017 (UTC)

• Support; the fact that there are pre-syncopal cases can be covered in a section.  — SMcCandlish ☺ ☏ ¢ ≽^ʌⱷ҅_ᴥⱷ^ʌ≼  03:46, 13 January 2017 (UTC)

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The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Support

Unclear were the ref says

"Food poisoning (e.g. Salmonella, etc)"

Is a cause of reflex syncope? Doc James (talk · contribs · email) 16:02, 14 November 2017 (UTC)

This ref says "shock and syncope in a patient with uncontrolled diabetes"[5] which means that it is LOC due to low BP that is not transient. Doc James (talk · contribs · email) 16:03, 14 November 2017 (UTC)

Interpret the diabetic patient's low BP as a contributing factor along with the NTS, resulting in "shock and syncope". Out of curiosity, I would like to know more about what details were observed with that patient's syncope, with regards to any seizure-like shaking to possibly indicate when blood flow/oxygen to the brain had been interrupted 149.101.1.122 (talk) 22:01, 15 November 2017 (UTC) DP

Causes and references/citations - Salmonella, Environmental triggers

Thank you for contributing to Wikipedia. Remember that when adding content about health, please only use high-quality reliable sources as references. We typically use review articles, major textbooks and position statements of national or international organizations (There are several kinds of sources that discuss health: here is how the community classifies them and uses them). WP:MEDHOW walks you through editing step by step. A list of resources to help edit health content can be found here. The edit box has a built-in citation tool to easily format references based on the PMID or ISBN. We also provide style advice about the structure and content of medicine-related encyclopedia articles. The welcome page is another good place to learn about editing the encyclopedia. If you have any questions, please feel free to drop me a note. Doc James (talk · contribs · email) 11:32, 14 November 2017 (UTC)

Hello, note that any other items (besides the Vasovagal/Reflex Syncope item that you created) on this IP@ talk page are not of my doing. I do not vandalize pages, just fyi. You didn't accuse me of this, I know, but had to state that.

I will review the guidelines on references/citations. I did use the citation tool, however.

So one of the 'food poisoning' references was sourced from the same 'high-quality' source as another reference (for the TMS cause) in the wiki article. This source refers to NTS, where salmonella caused severe hemorrhagic cystitis, leading a patient (with other complications, in this case) to 'syncope'. [6]

The other 'food poisoning' source cited salmonella ingestion correlated with an extreme drop in blood pressure. Although, it does not correlate this further with a vasovagal interruption episode, although that is mentioned later in the reference (as a drop in blood pressure is an underlying symptom). ["Low blood pressure and dizziness (MPKB)". Marshall Protocol Knowledge Base. Autoimmunity Research Foundation. Retrieved 13 November 2017.]

References on the correlation to salmonella are not easily found, and I am not a graduate student who may have more time to find them. The cause listed as 'Environmental triggers: light (television or strobe, as well), atmospheric or other such similarities to past syncope episodes' is something I have not seen referenced before. However, psychological and physiological triggers are known to contribute to causation and/or enhance symptoms, and I am very certain they played a role in my own experiences.

Personally, I have had FIVE episodes. Each time leading to a greater understanding of the reasons, indications and circumstances of my own syncope. Not all triggers/causes are relevant to everyone who has experienced this, as we know. Each episode, I can recall the details quite well (and my detection of onset improved each time, as experience goes). In EVERY one of my syncope episodes the common denominator has been the ingestion of chicken tainted with salmonella and time period of 8-9 hours. This created the physiological conditions that provide the window of opportunity where the resulting syncope can occur (combined with environmental factors, perhaps genetics and/or my own development). Two episodes were in an environment very similar to the first episode, the other three had just some environmental similarities. I feel it is very important to note this in the article, especially for those who may be able to further research and/or try to understand their own syncope's. I would not list anything that wasn't relevant or try to sway loose causation for personal/egotistical reasons. I would appreciate your help with my contribution to the article and feel we need to address this in the article. Thank you.

[NOTE: this was posted on Doc James talk page, but I figure it should be discussed by others as well)

149.101.1.122 (talk) 19:59, 15 November 2017 (UTC) DP

What we need is a high quality ref that actually supports the content in question. Please read WP:MEDRS Best Doc James (talk · contribs · email) 15:36, 16 November 2017 (UTC)

"brief periods of unconsciousness do no harm"

This is not generally true. Apart from possible injuries due to falls, it depends on the frequency of the syncopes if they do harm or not. If someone keeps fainting very often (e.g. multiple times per hour) for a long time, this is for sure not harmless and may result in chronic brain damage, among other problems. If however the fainting attacks are infrequent (like once in a week) they may be innocuous apart from causing falls. --79.240.195.252 (talk) 15:25, 19 August 2018 (UTC)