Vasovagal syncope

Diagnosis

Diagnosing vasovagal syncope often begins with a physical examination. During the physical exam, your doctor will listen to your heart and take your blood pressure. He or she may also massage the main arteries in your neck to see if that causes you to feel faint.

Your doctor may also recommend several tests to rule out other possible causes of your fainting — particularly heart-related problems. These tests may include:

• Electrocardiogram. This test records the electrical signals your heart produces. It can detect irregular heart rhythms and other cardiac problems. You may need to wear a portable monitor for at least a day or as long as a month.
• Echocardiogram. This test uses ultrasound imaging to view the heart and look for conditions, such as valve problems, that can cause fainting.
• Exercise stress test. This test studies heart rhythms during exercise. It's usually conducted while you walk or jog on a treadmill.
• Blood tests. Your doctor may look for conditions, such as anemia, that can cause or contribute to fainting spells.
• Tilt table test. If no heart problems appear to cause your fainting, your doctor may suggest that you undergo a tilt table test. During the test, you lie flat on your back on a table that changes positions, tilting you upward at various angles. A technician monitors your heart rhythms and blood pressure during the test to see if changing your posture affects them.

Treatment

In most cases of vasovagal syncope, treatment is unnecessary. Your doctor may help you identify your fainting triggers and discuss ways you might avoid them.

However, if you experience vasovagal syncope often enough to interfere with your quality of life, your doctor may suggest trying one or more of the following remedies:

• Medications. A drug called fludrocortisone acetate that's normally used to treat low blood pressure may be helpful in preventing vasovagal syncope. Selective serotonin reuptake inhibitors also may be used.
• Therapies. Your doctor may recommend ways to decrease the pooling of blood in your legs. These may include foot exercises, wearing compression stockings or tensing your leg muscles when standing. You may need to increase salt in your diet if you don't usually have high blood pressure. Avoid prolonged standing — especially in hot, crowded places — and drink plenty of fluids.
• Surgery. Very rarely, inserting an electrical pacemaker to regulate the heartbeat may help some people with vasovagal syncope who haven't been helped by other treatments.

Preparing for your appointment

It's a good idea to prepare for your appointment to make the most of your time with your doctor.

What you can do

• Write down details of your symptoms, including any triggers that may have caused you to faint.
• Make a list of any medications, vitamins and supplements you're taking.
• Write down questions you want to ask your doctor, including questions about potential tests and treatments.

What to expect from your doctor

Questions your doctor might ask you include:

• What were you doing just before you fainted?
• What signs and symptoms, if any, did you experience before you fainted?
• Have you ever fainted before? If yes, what were you doing before you fainted then?
• Have you recently started taking a new medication?
• Have you ever had a head injury?
• Has anyone in your family died suddenly of heart problems?