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Clinical characteristics of patients with vasovagal reactions presenting as unexplained syncope
1Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Objective:
To describe the clinical characteristics of vasovagal syncope (VVS) in patients presenting to a tertiary referral centre with unexplained syncope, in whom the diagnosis of VVS was confirmed by tilt table testing (HUT) and in whom other causes of syncope excluded.
Design:
Prospective study of 62 consecutive patients with more than two episodes of syncope in the past year.
Setting:
A regional tertiary referral centre for patients with unexplained syncope.
Patients:
Sixty-two patients, mean age 50 +/- 21 years, 39 female, were studied. Mean duration of symptoms was 5 years. Average frequency of attacks was one episode per week.
Interventions:
Detailed semi-structured questionnaires were completed regarding presenting symptoms.
Results:
In over one-third of patients, episodes occurred suddenly, with no prodromal features. In those with prodrome, 71% had autonomic symptoms, but 27% had palpitations or dyspnoea and 21% had chest pain. Eleven percent of patients denied known provocative features. In the remainder, the most common were prolonged standing (37%), hot weather (27%) and lack of food (23%). One-fifth had symptoms sitting and 5% whilst driving. Seventy-five percent of patients suffered after effects, the most common being severe fatigue. Over half sustained an injury during syncope, and 13% sustained a fracture. Unwitnessed episodes occurred in 25%. Pallor was reported in half the cases, sweating in 13% and myoclonus in 5%.
Conclusions:
Atypical presentations of VVS occur in many patients referred to a tertiary referral centre. Knowledge of the clinical characteristics of unexplained syncope for which VVS is the attributable diagnosis should assist in appropriate management of such patients.