[Therapy of vasovagal syncope (nonpharmacologic therapy and pharmacotherapy)]

Recurrent vasovagal syncope is a frequent clinical problem. Provisions regarding the regimen, non-pharmacological treatment and pharmacotherapy are the basic principles of management of patients with vasovagal syncope. Regimen provisions involve avoidance of predisposing factors and immediate horizontalization during initial presyncopal manifestations. Endurance training, tilt training, autogenous training and increased intake of salt and fluids are possible ways of non-pharmacological treatment. According to the relatively extensive number of published reports on pharmacological treatment of vasovagal syncope four preparations proved effective in randomized placebo controlled trials--atenolol, midodrin, paroxetin and enalapril. The author gives an account of non-pharmacological and pharmacological treatment of vasovagal syncope, whereby he concentrates on the validity and clinical importance of different trials.