Vasovagal syncope and head upright tilt table testing

Tilt testing for syncope

Vasovagal syncope is a common cause of sudden collapse. It results from inappropriate activation of left ventricular mechanoreceptors causing sudden vasodilation with bradycardia. Tilt testing is an inexpensive and non-invasive way of establishing a vasovagal diagnosis in unexplained syncope. If critical care nurses improve their understanding of the pathophysiology of vasovagal syncope and the procedure of tilt testing, their care of syncopal patients will be enhanced. This literature review discusses the pathophysiology and clinical presentation of vasovagal syncope. The procedure of tilt testing is explained and the treatment of vasovagal syncope is briefly reviewed.

Characteristics, perceived stressors, and coping strategies of patients who experience neurally mediated syncope

PURPOSE

The purpose of this study was to describe the characteristics, perceived stressors, and coping strategies of patients who experience neurally mediated syncope.

METHODS

Qualitative and quantitative analyses of 65 medical records including both written records and videotaped interviews were performed.

FINDINGS

The most frequently reported health problems were gastrointestinal disturbances (61.3%), mood disturbances (56.5%), headaches (53.2%), and chronic fatigue (47.4%). Risk for injury was high, with 54.1% of subjects indicating that they had an episode that resulted in a fall and 44.3% indicating that they had sustained an injury as a result of syncope. Distressing symptoms such as fatigue, dizziness, nausea, chest pain, headache, confusion, and dyspnea often persisted for hours or days after an episode of syncope. Coping strategies included limiting or changing activities and avoiding injury.

CONCLUSIONS

Neurally mediated syncope is a disruptive, distressing disorder that is a source of significant disability. Comprehensive care should include a holistic assessment of the impact of the disorder and appropriate referrals or interventions for psychologic, social, and occupational issues.

Vasodepressor syncope: the common faint

Perianesthesia patients and families are susceptible to vasodepressor syncope. Understanding the physiological mechanisms responsible for syncope, the Bezold-Jarisch reflex, will allow the perianesthesia nurse to minimize the physical and emotional sequele of the common faint.