[Pharma-clinics. How I treat vasovagal syncope]

Vaso-vagal syncope is generally thought to be triggered by a short episode of sympathetic stimulation immediately followed by an inappropriate reflex hemodynamic response (bradycardia-hypotension). The patient should be reassured and informed about the symptoms which precede syncope and about the benefit that muscular contractions of the legs may provide. Elastic stocking support may be useful. When pharmacological treatment is necessary, betablockers will be the initial choice for patients in whom syncope is clearly preceded by a sympathetic rise. In other instances, the treatment is less well delineated and may consist of fluid-NaCl therapy with fluorocortisone, or possibly an alpha-agonist, or a specific inhibitor of serotonin reuptake. Bi-chamber pacing should be reserved for patients with a marked cardio-inhibitory response and severe, frequently recurrent syncope. The benefit of tilt training deserves confirmation.