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Year 2013, Volume: 1 Issue: 3, 184 - 190, 09.10.2015

Abstract

Vasovagal syncope (VVS) is the most common cause of recurrent syncope which has a good prognosis, but has a high morbidity. structural heart disease is absent in most of the patients. It is thought to be the result of neurocardiovascular system abnormality which provides the systemic and cerebral perfusion. Although VVS has a high incidence, no satisfactory treatment has been found yet. The main purpose of the treatment is to prevent the recurrent syncope episodes and injuries that may occur due to syncope and to improve the quality of life. Treatment of VVS is divided into three as nonpharmacological treatment, pharmacological treatment and cardiac pacemaker implantation. The treatment of VVS is difficult. The patient should be given detailed information about the disease, proper diet should be recommended by the life-style changes, triggerering factors of the syncope should be explained and advised to avoid these triggers. Psychological support is very important and should be maintained in these patients. Patients should be strongly encouraged to implement physical maneuvers. Medical treatment can be tried if the patients’ complaints continue. In case of recurrent syncope despite ongoing medical treatment, permanent pacemaker implantation should be considered

References

  • Vaddadi G, Lambert E, Corcoran SJ, Esler MD. Postural syncope: mechanisms and management. Med J Aust 2007;187:299-304.
  • Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, wieling W, van dijk N. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol 2006;17:1172-6.
  • Fenton AM, Hammill SC, Rea RF, Low PA, Shen syncope. WK. 2000;133:714-25. Ann Intern Med
  • Barbara K. Blok, Tina M. Newman. Syncope. In Judith E. Tintinally, MD, MS, Editör. Emergency Medicine. 6th ed. New York: Mc Graw-Hill; 2004. p: 359-64.
  • Linzer M, Gold DT, Pontinen M, Divine GW, Felder A, Brooks WB. Recurrent syncope as a chronic disease: preliminary validation of a disease-specific measure of functional impairment. J Gen Intern Med 1994;9:181-6.
  • Nowak L, Nowak FG, Janko S, Dorwarth U, Hoffmann E, Botzenhardt F. Investigation of various types of neurocardiogenic response to head-up tilting by extended hemodynamic and neurohumoral monitoring. Pacing Clin Electrophysiol 2007;30: 623- 30.
  • Claydon VE, Schroeder C, Norcliffe LJ, Jordan J, Hainsworth R. Water drinking improves orthostatic tolerance in patients with posturally related syncope. Clin Sci (Lond) 2006;110: 343-52.
  • Brignole M, Croci F, Menozzi C, Solano A, Donateo P, Oddone D, Puggioni E, Lolli G. Isometric arm counter-pressure maneuvers to abort impending vasovagal 2002;40:2053-9. Am Coll Cardiol
  • Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002;106:1684-9.
  • Foglia-Manzillo G, Giada F, Gaggioli G, Bartoletti A, Lolli G, Dinelli M, Del Rosso A, Santarone M, Raviele A, Brignole M. Efficacy of tilt training in the treatment randomized study. Europace 2004;6:199-204.
  • Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C et al. Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 2006;113:1164-70.
  • Di Girolamo E, Di Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999;33:1227-30.
  • Grubb BP, Wolfe DA, Samoil D, Temesy-Armos P, Hahn H, Elliott L. Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced 1993;16:458-64. Clin Electrophysiol
  • Kaufman H, Saadia D, Voustianiouk A. Midodrine in neurally randomized 2002;52:342-5. a double-blind cross-over study. Ann Neurol
  • Ward CR, Gray JC, Gilroy JJ, Kenny RA. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998;79:45-9.
  • Raviele A, Brignole M, Sutton R, Alboni P, Giani P, Menozzi C, Moya A. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo- controlled trial. The Vasovagal Syncope International Study. Circulation 1999;99:1452-7.
  • Salim MA, Di Sessa TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double blind, placebo- controlled, randomized trial. J Am Coll Cardiol 2005;45:484-8.
  • Lee TM, Su SF, Chen MF, Liau CS, Lee YT. transdermal vasovagal syncope. Am J Cardiol 1996;78:480-2.
  • Nelson SD, Stanley M, Love CJ, Coyne KS, Schaal SF. The autonomic and hemodynamic effects of oral theophylline in patients with vasodepressor syncope. Arch Intern Med 1991;151:2425-9.
  • Morillo CA, Leitch JW, Yee R, Klein GJ. A placebo- controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993;22:1843-8.
  • Milstein S, Buetikofer J, Dunnigan A, Benditt DG, Gornick C, Reyes WJ. Usefulness of disopyramide for prevention of upright tilt-induced hypotension- bradycardia. Am J Cardiol 1990;65:1339-4.
  • Sra JS, Jazayeri MR, Avitall B, Dhala A, Deshpande S, Blanck Z, Akhtar M. Comparison of cardiac pacing with in neurocardiogenic bradycardia 1993;328:1085-90. the treatment syncope Engl Med asystole. or N J
  • Fitzpatrick AP, Travill CM, Vardas PE, Hubbard WN, Wood A, Ingram A, Sutton R. Recurrent symptoms after ventricular pacing in unexplained syncope. Pacing Clin Electrophysiol 1990;13:619-24.
  • Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, Moya A. Dual-chamber pacing in the treatment cardioinhibitory syncope : pacemaker versus no mediated tilt-positive therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation 2000;102:294-9.
  • Ammirati F, Colivicchi F, Santini M; Syncope Diagnosis and Treatment Study Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001;104:52-7
  • Connolly SJ, Sheldon R, Roberts RS, Gent M. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999;33:16-20.
  • Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, Morillo C, Gent M; VPS II Investigators. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 2003;289:2224-9.
  • Raviele A, Giada F, Menozzi C, Speca G, Orazi S, Gasparini G, Sutton R, Brignole M; Vasovagal Syncope randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur Heart J 2004;25:1741-8
  • Trial Investigators. A
  • Sud S, Massel D, Klein GJ, Leong-Sit P, Yee R, Skanes AC, Gula LJ, Krahn AD. The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med 2007;120:54-62.

Vasovagal Senkobun Tedavisi

Year 2013, Volume: 1 Issue: 3, 184 - 190, 09.10.2015

Abstract

Özet:
Rekürren senkobun en sık nedeni olan Vazovagal Senkop (VVS), prognozu iyi olmakla birlikte yüksek morbiditeye sahiptir. Hastaların çoğunda yapısal bir kalp hastalığı yoktur. Bu hastalığın sistemik ve serebral perfüzyonu sağlayan nörokardiyovasküler sistemin anormalliği sonucu oluştuğu düşünülmektedir. VVS’un insidansı yüksek olmakla birlikte, henüz tedavisi tatmin edici düzeyde değildir. Tedavideki temel amaç, hastanın senkop rekürrenslerini ve senkoba bağlı oluşabilecek sakatlıkları önlemek, yaşam kalitesini artırmaktır. VVS’un tedavisi, non-farmakolojik tedavi, farmakolojik tedavi ve kardiyak pacemaker uygulaması olarak üç sınıfta toplanmaktadır. VVS’nin tedavisi zorludur. Hastaya, hastalığı ile ilgili ayrıntılı bilgi verilmeli, uygun diyete göre yaşam şekli değişikliği önerilmeli, senkobu tetikleyen faktörler iyi anlatılmalı ve bunlardan kaçınması tavsiye edilmelidir. Bu hastalarda psikolojik destek çok önemlidir ve mutlaka sağlanmalıdır. Fiziksel manevraların uygulanması için hastalar ciddi şekilde teşvik edilmelidir. Bu önerilere rağmen şikayetleri devam eden hastalarda medikal tedavi seçenekleri denenebilir. Medikal tedaviye rağmen senkop rekürrensleri devam eden hastalarda kalıcı pacemaker tedavisi seçenek olarak düşünülmelidir.



Abstract:
Vasovagal syncope (VVS) is the most common cause of recurrent syncope which has a good prognosis, but has a high morbidity. structural heart disease is absent in most of the patients. It is thought to be the result of neurocardiovascular system abnormality which provides the systemic and cerebral perfusion. Although VVS has a high incidence, no satisfactory treatment has been found yet. The main purpose of the treatment is to prevent the recurrent syncope episodes and injuries that may occur due to syncope and to improve the quality of life. Treatment of VVS is divided into three as non-pharmacological treatment, pharmacological treatment and cardiac pacemaker implantation. The treatment of VVS is difficult. The patient should be given detailed information about the disease, proper diet should be recommended by the life-style changes, triggerering factors of the syncope should be explained and advised to avoid these triggers. Psychological support is very important and should be maintained in these patients. Patients should be strongly encouraged to implement physical maneuvers. Medical treatment can be tried if the patients’ complaints continue. In case of recurrent syncope despite ongoing medical treatment, permanent pacemaker implantation should be considered.

References

  • Vaddadi G, Lambert E, Corcoran SJ, Esler MD. Postural syncope: mechanisms and management. Med J Aust 2007;187:299-304.
  • Ganzeboom KS, Mairuhu G, Reitsma JB, Linzer M, wieling W, van dijk N. Lifetime cumulative incidence of syncope in the general population: a study of 549 Dutch subjects aged 35-60 years. J Cardiovasc Electrophysiol 2006;17:1172-6.
  • Fenton AM, Hammill SC, Rea RF, Low PA, Shen syncope. WK. 2000;133:714-25. Ann Intern Med
  • Barbara K. Blok, Tina M. Newman. Syncope. In Judith E. Tintinally, MD, MS, Editör. Emergency Medicine. 6th ed. New York: Mc Graw-Hill; 2004. p: 359-64.
  • Linzer M, Gold DT, Pontinen M, Divine GW, Felder A, Brooks WB. Recurrent syncope as a chronic disease: preliminary validation of a disease-specific measure of functional impairment. J Gen Intern Med 1994;9:181-6.
  • Nowak L, Nowak FG, Janko S, Dorwarth U, Hoffmann E, Botzenhardt F. Investigation of various types of neurocardiogenic response to head-up tilting by extended hemodynamic and neurohumoral monitoring. Pacing Clin Electrophysiol 2007;30: 623- 30.
  • Claydon VE, Schroeder C, Norcliffe LJ, Jordan J, Hainsworth R. Water drinking improves orthostatic tolerance in patients with posturally related syncope. Clin Sci (Lond) 2006;110: 343-52.
  • Brignole M, Croci F, Menozzi C, Solano A, Donateo P, Oddone D, Puggioni E, Lolli G. Isometric arm counter-pressure maneuvers to abort impending vasovagal 2002;40:2053-9. Am Coll Cardiol
  • Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002;106:1684-9.
  • Foglia-Manzillo G, Giada F, Gaggioli G, Bartoletti A, Lolli G, Dinelli M, Del Rosso A, Santarone M, Raviele A, Brignole M. Efficacy of tilt training in the treatment randomized study. Europace 2004;6:199-204.
  • Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C et al. Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation 2006;113:1164-70.
  • Di Girolamo E, Di Iorio C, Sabatini P, Leonzio L, Barbone C, Barsotti A. Effects of paroxetine hydrochloride, a selective serotonin reuptake inhibitor, on refractory vasovagal syncope: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 1999;33:1227-30.
  • Grubb BP, Wolfe DA, Samoil D, Temesy-Armos P, Hahn H, Elliott L. Usefulness of fluoxetine hydrochloride for prevention of resistant upright tilt induced 1993;16:458-64. Clin Electrophysiol
  • Kaufman H, Saadia D, Voustianiouk A. Midodrine in neurally randomized 2002;52:342-5. a double-blind cross-over study. Ann Neurol
  • Ward CR, Gray JC, Gilroy JJ, Kenny RA. Midodrine: a role in the management of neurocardiogenic syncope. Heart 1998;79:45-9.
  • Raviele A, Brignole M, Sutton R, Alboni P, Giani P, Menozzi C, Moya A. Effect of etilefrine in preventing syncopal recurrence in patients with vasovagal syncope: a double-blind, randomized, placebo- controlled trial. The Vasovagal Syncope International Study. Circulation 1999;99:1452-7.
  • Salim MA, Di Sessa TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children: a double blind, placebo- controlled, randomized trial. J Am Coll Cardiol 2005;45:484-8.
  • Lee TM, Su SF, Chen MF, Liau CS, Lee YT. transdermal vasovagal syncope. Am J Cardiol 1996;78:480-2.
  • Nelson SD, Stanley M, Love CJ, Coyne KS, Schaal SF. The autonomic and hemodynamic effects of oral theophylline in patients with vasodepressor syncope. Arch Intern Med 1991;151:2425-9.
  • Morillo CA, Leitch JW, Yee R, Klein GJ. A placebo- controlled trial of intravenous and oral disopyramide for prevention of neurally mediated syncope induced by head-up tilt. J Am Coll Cardiol 1993;22:1843-8.
  • Milstein S, Buetikofer J, Dunnigan A, Benditt DG, Gornick C, Reyes WJ. Usefulness of disopyramide for prevention of upright tilt-induced hypotension- bradycardia. Am J Cardiol 1990;65:1339-4.
  • Sra JS, Jazayeri MR, Avitall B, Dhala A, Deshpande S, Blanck Z, Akhtar M. Comparison of cardiac pacing with in neurocardiogenic bradycardia 1993;328:1085-90. the treatment syncope Engl Med asystole. or N J
  • Fitzpatrick AP, Travill CM, Vardas PE, Hubbard WN, Wood A, Ingram A, Sutton R. Recurrent symptoms after ventricular pacing in unexplained syncope. Pacing Clin Electrophysiol 1990;13:619-24.
  • Sutton R, Brignole M, Menozzi C, Raviele A, Alboni P, Giani P, Moya A. Dual-chamber pacing in the treatment cardioinhibitory syncope : pacemaker versus no mediated tilt-positive therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators. Circulation 2000;102:294-9.
  • Ammirati F, Colivicchi F, Santini M; Syncope Diagnosis and Treatment Study Investigators. Permanent cardiac pacing versus medical treatment for the prevention of recurrent vasovagal syncope: a multicenter, randomized, controlled trial. Circulation 2001;104:52-7
  • Connolly SJ, Sheldon R, Roberts RS, Gent M. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope. J Am Coll Cardiol 1999;33:16-20.
  • Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, Morillo C, Gent M; VPS II Investigators. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA 2003;289:2224-9.
  • Raviele A, Giada F, Menozzi C, Speca G, Orazi S, Gasparini G, Sutton R, Brignole M; Vasovagal Syncope randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). Eur Heart J 2004;25:1741-8
  • Trial Investigators. A
  • Sud S, Massel D, Klein GJ, Leong-Sit P, Yee R, Skanes AC, Gula LJ, Krahn AD. The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med 2007;120:54-62.
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Derlemeler
Authors

Muhammed Oylumlu

Adnan Doğan

Publication Date October 9, 2015
Published in Issue Year 2013 Volume: 1 Issue: 3

Cite

APA Oylumlu, M., & Doğan, A. (2015). Vasovagal Senkobun Tedavisi. International Journal of Basic and Clinical Medicine, 1(3), 184-190.
AMA Oylumlu M, Doğan A. Vasovagal Senkobun Tedavisi. International Journal of Basic and Clinical Medicine. October 2015;1(3):184-190.
Chicago Oylumlu, Muhammed, and Adnan Doğan. “Vasovagal Senkobun Tedavisi”. International Journal of Basic and Clinical Medicine 1, no. 3 (October 2015): 184-90.
EndNote Oylumlu M, Doğan A (October 1, 2015) Vasovagal Senkobun Tedavisi. International Journal of Basic and Clinical Medicine 1 3 184–190.
IEEE M. Oylumlu and A. Doğan, “Vasovagal Senkobun Tedavisi”, International Journal of Basic and Clinical Medicine, vol. 1, no. 3, pp. 184–190, 2015.
ISNAD Oylumlu, Muhammed - Doğan, Adnan. “Vasovagal Senkobun Tedavisi”. International Journal of Basic and Clinical Medicine 1/3 (October 2015), 184-190.
JAMA Oylumlu M, Doğan A. Vasovagal Senkobun Tedavisi. International Journal of Basic and Clinical Medicine. 2015;1:184–190.
MLA Oylumlu, Muhammed and Adnan Doğan. “Vasovagal Senkobun Tedavisi”. International Journal of Basic and Clinical Medicine, vol. 1, no. 3, 2015, pp. 184-90.
Vancouver Oylumlu M, Doğan A. Vasovagal Senkobun Tedavisi. International Journal of Basic and Clinical Medicine. 2015;1(3):184-90.