Vasovagal syncope after drinking alcohol12/27/2023 ![]() In vasovagal syncope with asystole, cardiac pacing may be effective in preventing syncope when tilt testing is negative. ++ stronger evidence for use of this medication Pacemakers + may be used in this condition, weaker evidence Intravenous fluids (when acutely decompensated) Medication used in V V Syncope, OH and PoTSĭownload Medication used in V V Syncope, OH and PoTS (52 KB PDF) Evidence for medication in VVS, OH and PoTS MedicationĢ.5-10 mg TDS -last dose at about 6pm (higher dose sometimes used in PoTS) Others may be prescribed under a shared care agreement. ![]() The only medication listed below that has marketing authorisation (‘is licensed’) for the use indicated is midodrine for refractory orthostatic hypotension.In PoTS some also aim to blunt the tachycardia Drugs mostly aim to increase blood volume and constrict blood vessels.The evidence base for medication is limited.Medication should be used if self-management techniques have failed to improve symptoms and is used in combination with these.Medication used in orthostatic hypotension, vasovagal syncope and PoTS: See the section on Cardiac syncope for medication in cardiac conditions. This short YouTube video 'How can I prevent a syncopal episode?' describes how patients with vasovagal syncope can prevent syncope using postural countermeasures. Images used with consent of Prof Wouter Wieling. These measures can raise blood pressure in VVS and OH, and lower heart rate in PoTS. Postural counterpressure manoeuvres (see image below)Įlevate head end of the bed by 10-20 degrees Rapid water drinking (two lots of 8oz boluses) Maintain high fluid intake of 2-4 litres a day in adults Stop medication that can provoke tachycardiaĪvoid triggers such as standing, heat, alcohol, rich meals Stop medication that lowers blood pressure Medical alert bracelets can be useful for people who faint regularly.Postural counterpressure-manoeuvres (see images below).Compression such as waist high tights or compression sports clothing, abdominal binder.Diet, for example regular meals, fibre to prevent straining in defaecation syncope and avoid heavy meals in post-prandial hypotension.Additional salt, from 6-10g a day (unless contraindicated).Maintaining good fluid intake of 2-2.5 litres a day in adults - advise two cups of water before rising.Avoiding triggers such as prolonged standing, heat, alcohol.Orthostatic hypotension (OH) - useful in many types of OH (but not in acute volume depletion).The following are useful techniques to relieve symptoms and prevent syncope in the following conditions: See the section on Cardiac syncope for management of individual cardiac conditions.
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