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Patient Autonomic mediated (neurocardiogenic)

Patient
Information
Information
syncope
Introduction
This leaflet will give you information about syncope and some
ideas which may help you to manage the condition.

What is syncope?
Syncope is a faint, or short loss of consciousness, causing
collapse with a natural recovery. Other terms used to describe
syncope include ‘blackout’, or ‘drop attack’. Syncope may be
caused by a number of things such as a drop in blood pressure,
change in heart rhythm, low blood sugar or breathing too
quickly (known as hyperventilation).

Simple fainting (benign vasovagal syncope)

This is the most common cause of collapse in all age groups. It
happens most often in young adults. It is not often seen for the
first time in older people. Fainting may be brought on by, for
example, the sight of blood, a sudden noise or severe pain and
is linked with warning symptoms such as feeling sick (nausea),
sweating and loss of skin colour. Injury to the person fainting
does not often happen.

Autonomic mediated syncope

Autonomic mediated syncope, also known as neurocardiogenic
syncope or vasovagal syncope may happen for the first time at
any age.
It often happens when someone is standing up, but can happen
when they are sitting down.
Reference No. It rarely happens when lying down. These faints are more likely
GHPI0319_07_17 to happen in certain situations, such as when eating a large
Department meal in a warm room, during long haul flights or after standing
Assessment and for a long time.
Rehabilitation
Unit When people collapse in this way, it may be sudden or start
Review due with warning symptoms.
July 2020

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Examples of these include tiredness, weakness, feeling sick,

Patient sweating, loss of colour vision, tummy discomfort, headache,
Information pins-and-needles, light-headedness or spinning sensation.
These symptoms may last for seconds or minutes. Older
people may not have these warning symptoms.
When people collapse, they usually lie very still. Sometimes
they start shaking. This shaking is due to less oxygen getting to
the brain and may be mistaken for epilepsy.
When people start to become more aware they may feel sick,
clammy, light-headed or tired. They may also complain of a
headache and feel clammy to touch. Some people may not be
able to stand up for several minutes. Full recovery can take up
to a few hours.

Treatment of autonomic mediated syncope

Sometimes the best treatment for syncope is not medication.
Below are some ideas that may help you to manage syncope:
How can I help myself?
1. Try to avoid situations that are likely to cause you to
collapse. You will know what these situations are by thinking
about when you have collapsed in the past. Situations may
include: standing in a queue, taking a long hot bath, eating a
large carbohydrate-rich meal in a warm room, or not drinking
enough fluid in a hot setting
2. If you think you are about to collapse, try to lie down flat
propping your legs up on a chair or against a wall. If you
cannot lie down, squatting can be good and is less likely to
attract attention. Sitting down with your head between your
knees can help, but does not work as well as lying down or
squatting. These actions should improve your blood
pressure and keep blood flowing to your brain. When you
feel better, get up carefully. If your symptoms return or get
worse lie down or squat again
3. Simple exercises can help prevent you from collapsing, for
example rocking backwards and forwards on your heels
when standing or in a queue

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4. Make sure that you drink enough fluid each day. You know
Patient you are drinking enough when you pass clear, pale coloured
Information urine. You can drink 200mls (one glass) of water to quickly
increase your blood pressure, which may be helpful in
stopping you from collapsing 5. If your blood pressure is not
high and our tests show that you are not eating enough salt
we will advise you to eat more.
5. We can easily check by measuring how much sodium (salt)
you pass in a 24 hour urine sample. Your salt intake can be
increased by adding salt at the table, taking salt tablets (slow
sodium) or drinking ‘sport’ drinks. A recent study shows that
between 3g and 7g of sodium each day may be ideal. As a
guide, 5g teaspoonful of salt has 2.3g sodium. Avoid ‘junk’
foods which contain high levels of cholesterol as well as salt.
The benefits of increasing salt intake are noticed within 2 or
3 days. You should not increase your salt intake if you have
high blood pressure
6. Try to sleep with the head of your bed raised slightly. This
helps to reduce the amount of urinary salt that you lose
overnight.

Medication
A range of medications can be used to treat autonomic
mediated syncope. Those most often used include
Fludrocortisone, Midodrine, Bisoprolol and Fluoxetine
(Prozac®). The fact that so many different medications are
used for treatment shows that none of them are a cure on their
own. If one drug does not help then another prescribed drug
may. Sometimes, a mixture of drugs is needed.

Pacemaker
There are times when a patient needs to have a permanent
pacemaker fitted. You will receive further information if a
pacemaker is required

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Contact information
Patient
If you have any questions or queries please do not hesitate to
Information contact:
Syncope Clinic
Gloucestershire Royal Hospital
Tel: 0300 422 5673
Monday to Friday, 9:00 am to 5:00pm

Further information
More information can be found on the following website:
Gloucestershire Syncope Clinic
www.syncope.co.uk

Content reviewed: July 2017

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