Reflex syncope
Reflex syncope is a brief loss of consciousness due to a neurologically induced drop in blood pressure and/or a decrease in heart rate. Before an affected person passes out, there may be sweating, a decreased ability to see, or ringing in the ears. Occasionally, the person may twitch while unconscious. Complications of reflex syncope include injury due to a fall.
| Reflex syncope | |
|---|---|
| Other names | Neurally mediated syncope, neurocardiogenic syncope |
| Vagus nerve | |
| Specialty | Neurology, cardiovascular |
| Symptoms | Loss of consciousness before which there may be sweating, decreased ability to see, ringing in the ears |
| Complications | Injury |
| Duration | Brief |
| Types | Vasovagal, situational, carotid sinus syncope |
| Diagnostic method | Based on symptoms after ruling out other possible causes |
| Differential diagnosis | Arrhythmia, orthostatic hypotension, seizure, hypoglycemia |
| Treatment | Avoiding triggers, drinking sufficient fluids, exercise, cardiac pacemaker |
| Medication | Midodrine, fludrocortisone |
| Frequency | > 1 per 1,000 people per year |
Reflex syncope is divided into three types: vasovagal, situational, and carotid sinus. Vasovagal syncope is typically triggered by seeing blood, pain, emotional stress, or prolonged standing. Situational syncope is often triggered by urination, swallowing, or coughing. Carotid sinus syncope is due to pressure on the carotid sinus in the neck. The underlying mechanism involves the nervous system slowing the heart rate and dilating blood vessels, resulting in low blood pressure and thus not enough blood flow to the brain. Diagnosis is based on the symptoms after ruling out other possible causes.
Recovery from a reflex syncope episode happens without specific treatment. Prevention of episodes involves avoiding a person's triggers. Drinking sufficient fluids, salt, and exercise may also be useful. If this is insufficient for treating vasovagal syncope, medications such as midodrine or fludrocortisone may be tried. Occasionally, a cardiac pacemaker may be used as treatment. Reflex syncope affects at least 1 in 1,000 people per year. It is the most common type of syncope, making up more than 50% of all cases.