Autonomic_mediated_neurocardiogenic_syncope_ghpi0319_07_17.pdf
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Patient Patient Information Information
Autonomic mediated (neurocardiogenic) 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. GHPI0319_07_17 Department Assessment and Rehabilitation Unit Review due
It rarely happens when lying down. These faints are more likely to happen in certain situations, such as when eating a large meal in a warm room, during long haul flights or after standing for a long time. When people collapse in this way, it may be sudden or start with warning symptoms.
July 2020
www.gloshospitals.nhs.uk
Page 2 of 4
Patient Information
Examples of these include tiredness, weakness, feeling sick, sweating, loss of colour vision, tummy discomfort, headache, 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
www.gloshospitals.nhs.uk
Page 3 of 4
Patient Information
4. Make sure that you drink enough fluid each day. You know you are drinking enough when you pass clear, pale coloured 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
www.gloshospitals.nhs.uk
Page 4 of 4
Contact information Patient Information
If you have any questions or queries please do not hesitate to 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
www.gloshospitals.nhs.uk
Patient Patient Information Information
Autonomic mediated (neurocardiogenic) 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. GHPI0319_07_17 Department Assessment and Rehabilitation Unit Review due
It rarely happens when lying down. These faints are more likely to happen in certain situations, such as when eating a large meal in a warm room, during long haul flights or after standing for a long time. When people collapse in this way, it may be sudden or start with warning symptoms.
July 2020
www.gloshospitals.nhs.uk
Page 2 of 4
Patient Information
Examples of these include tiredness, weakness, feeling sick, sweating, loss of colour vision, tummy discomfort, headache, 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
www.gloshospitals.nhs.uk
Page 3 of 4
Patient Information
4. Make sure that you drink enough fluid each day. You know you are drinking enough when you pass clear, pale coloured 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
www.gloshospitals.nhs.uk
Page 4 of 4
Contact information Patient Information
If you have any questions or queries please do not hesitate to 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
www.gloshospitals.nhs.uk
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