Vasovagal Syncope

"Vasovagal syncope" is both the most prevalent form of neuro-card iogenic syncope and the most common cause of syncope. Many elinical situations may predispose to vasovagal syncope. Identification of various c ircumstances as "trigger" of syncopal attack is important not only for the diagnosis but also for the treatment and prevention of recurrent episodes. In many cases, prodromal symptoms occuıTing several seconds before the syncope are often observed, and these may be considered as the signals of danger. Prognosis of vasovagal syncope is generally benign. However, physical injury may result from syncopal episodes in patients without prodromal symptoms or in particular situations that individuals are working in a risky environment. Recurrence rate of vasovagal syncope is quite variable, corre lated with the number of syncopal ep isodes reported. Pathophys iologic basis of vasovagal syncope has not been precisely understood. It can be summarized that in patients susceptible to vasovagal syncope, continuity of the adaptive mechanisms maintaining the normal systemic pressure and the cerebral perfusion are impaired, and this impairment leads to an unexpected vasodilation and/or bradycardia which cause a decrease in cerebral perfusion and syncope. In the last decade, head-up tilt table testing has been the preferred diagnost ic test for the differential diagnos is of vasovagal syncope. Therapeutic options for th is elinical situation may be classified as acute interventions during the syncopal episodes, treatment strategies for the recurrences and fina lly the preventive approaches.