Vasovagal Syncope: Causes and Recovery Tips

Fainting without any apparent reason?

Yesterday morning, from 9:00 to 10:00, I was practicing riding a motorcycle outside.
After that, a kind person came to teach me some exam techniques for about 10 minutes.
I started to feel my vision narrowing and turning black, and then I fainted.
My mom woke me up, but I still felt dizzy and my vision was still dark.
It took a few minutes before I could see the objects in front of me clearly.
Later, my dad took me to see a doctor, who diagnosed me with vasovagal syncope.
No medication was needed, and after lying down for three hours at home, I felt better and ate some food.
Before fainting, I didn't feel any discomfort.
Today, whenever I stand for a few minutes, my head starts to feel dizzy again, so I am afraid to stand for too long.
Is this normal, or could it be low blood pressure? Today, I also experienced a sensation of ear fullness, but I have always had issues with my Eustachian tube, which often gets blocked.
When I saw the doctor yesterday, my blood pressure was 122/76.

Gina, 10~19 year old female. Ask Date: 2017/08/24

Dr. Chen Taicheng reply Family Medicine

It is indeed possible that the cause of vasovagal syncope is prolonged standing, leading to blood pooling in the lower extremities and resulting in lower blood pressure, which can cause fainting.
The causes of syncope are numerous, and the first step is to rule out cardiac-related issues, including arrhythmias and structural heart problems (including valve issues), which have already been evaluated by cardiology.
Please pay attention to whether your pulse is too slow (normal is about 60-90 beats per minute) or if you occasionally experience palpitations (or a sensation of irregular heartbeats).
If so, a 24-hour Holter monitor may be necessary to identify any arrhythmias.
The most common cause of syncope is neurogenic reflex syncope, with vasovagal syncope being the most prevalent.
The vagus nerve is part of the autonomic nervous system, controlling internal organs and blood vessels.
Situations such as prolonged standing, sitting, sudden postural changes, stress (like blood draws), pain, and sleep deprivation can trigger this type of syncope, as can situational factors (such as coughing or using the restroom).
This type of syncope is common but has a good prognosis.
A small subset of individuals may have hypersensitivity of the carotid sinus (which monitors and regulates blood pressure), where excessive sensitivity can lead to drops in blood pressure and heart rate, particularly when compressing both carotid arteries or bending the neck.
To check for orthostatic hypotension, measure blood pressure while lying down or sitting, then measure it again immediately after standing.
A positive result is indicated by a decrease of 20 mmHg in systolic blood pressure or 10 mmHg in diastolic blood pressure.
To confirm whether orthostatic hypotension is present, you can perform the above tests.
However, conditions such as anemia, Eustachian tube dysfunction, and arrhythmias may also exacerbate feelings of dizziness or fainting, so it is advisable to seek medical evaluation to rule these out.
Wishing you good health, Dr.
Chen Tai-Cheng, Family Medicine, Taoyuan Hospital.

Reply Date: 2017/08/24

More Info

Vasovagal syncope, commonly referred to as fainting, is a sudden, temporary loss of consciousness that occurs due to a drop in blood flow to the brain. This condition is often triggered by stress, pain, or prolonged standing, and it is typically benign. In your case, it seems that the episode occurred after standing for an extended period while practicing motorcycle skills, which aligns with common triggers for vasovagal syncope.

Causes of Vasovagal Syncope
The primary mechanism behind vasovagal syncope involves the autonomic nervous system, which regulates involuntary bodily functions. When a person experiences a trigger, such as standing for too long, the body may overreact, causing a sudden drop in heart rate and blood pressure. This leads to reduced blood flow to the brain, resulting in fainting. Other common triggers include:
1. Emotional Stress: Anxiety, fear, or pain can provoke a vasovagal response.

2. Physical Stress: Standing for long periods, dehydration, or overheating can contribute.

3. Medical Conditions: Certain conditions like dehydration, low blood sugar, or heart problems can increase susceptibility.

Recovery and Management
1. Rest and Hydration: After an episode, lying down and elevating your legs can help restore blood flow to the brain. Staying well-hydrated is crucial, as dehydration can exacerbate symptoms.

2. Avoiding Triggers: Identifying and avoiding situations that lead to fainting is essential. For instance, if standing for long periods triggers your symptoms, try to shift your weight or sit down when possible.

3. Gradual Position Changes: When transitioning from lying down or sitting to standing, do so slowly to allow your body to adjust and prevent sudden drops in blood pressure.

4. Physical Conditioning: Engaging in regular physical activity can improve your overall cardiovascular health and may help reduce the frequency of syncope episodes.

5. Dietary Considerations: Eating small, frequent meals can help maintain stable blood sugar levels, which may prevent fainting spells. Additionally, increasing salt intake (with medical advice) can help retain fluid and increase blood volume, potentially reducing the likelihood of syncope.

Monitoring Symptoms
Given your recent experience, it’s important to monitor your symptoms closely. The fact that you feel dizzy upon standing and experience ear fullness could indicate that your body is still adjusting after the fainting episode. While your blood pressure reading of 122/76 is within normal limits, fluctuations can occur, especially if you are feeling anxious or dehydrated.

If your symptoms persist or worsen, or if you experience additional concerning symptoms such as severe headaches, chest pain, or prolonged dizziness, it would be prudent to follow up with your healthcare provider. They may consider further evaluation to rule out other potential causes of your symptoms, such as orthostatic hypotension (a drop in blood pressure upon standing) or other cardiovascular issues.

Conclusion
In summary, vasovagal syncope is generally not a cause for alarm, but it does require some lifestyle adjustments and awareness of your body’s signals. By managing your triggers, staying hydrated, and monitoring your symptoms, you can reduce the likelihood of future episodes. If you have ongoing concerns or if your symptoms change, do not hesitate to seek medical advice for further evaluation and management.

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