Syncope: How To Diagnose and Manage Vasovagal Syncope

Dr Boon Lim was invited by the British Junior Cardiology Association and the British Cardiovascular Society to deliver an educational webinar on syncope. In this webinar, Dr. Lim discussed the diagnosis and management of vasovagal syncope.

In this webinar, Dr. Lim was able to discuss the following points:

The key principles for accurate diagnosis of syncope, including an emphasis on the history, clinical examination, and appropriate diagnostic testing, including the electrocardiogram (ECG), blood pressure monitor (ABPM) and active stand testing, where the patient is able to perform active stand testing by repeated measurements of BP whilst sitting for 3-5 minutes, followed by 5-10 minutes of repeated BP testing.

In addition, Dr. Lim discussed the role of tilt table testing and the role of ambulatory ECG monitoring (ECG) as well as the role of the implantable loop recorder (ILR), of which the most common is the Medtronic LINQ device. Several examples of cases of challenging-to-manage syncope are discussed with
comprehensive management strategies discussed.

In particular elderly patients who suffer from orthostatic intolerance, as well as labile blood pressures (Where BP are both high and low) are discussed. In these cases, management can be challenging but the emphasis was on avoiding injury, and it may be necessary to accept higher-than-normal blood pressures if this is needed to avoid injury through postural hypotension.

I Think I Have Vasovagal Syncope: Do I Need To See A Specialist Doctor?

Strategies include:

1) Drinking copiously (aiming for 2-2.5L a day) if tolerated

2) Considering compression garments, including lower limb stockings or abdominal
girdles/compression

3) Reducing or stopping anti-hypertension medications. Common drugs are diuretics (e.g.
bendroflumethiazide, frusemide, and other drugs include beta-blockers (metoprolol,
bisoprolol), ACE inhibitors (lisinopril, perindopril, ramipril), alpha-blockers (doxazosin), nitrates,
angiotensin 2 receptor blockers (losartan, candesartan, irbesartan).

4) Sleeping with the head tilted upright 10 to 15 degrees

5) Taking early evasive action on recognition of pre-syncopal symptoms

6) Isometric Counter-pressure exercises.

Dr. Lim also discussed the judicious use of midodrine in certain circumstances where patients continue
to be symptomatic despite optimal conservative therapy.
To watch this video, please click on this link: https://bjca.tv/aiovg_videos/syn/