Management of vasovagal syncope: Controlling or aborting faints by leg crossing and muscle tensing

• Published in: Circulation (New York, N.Y.) N.Y.), 2002-09, Vol.106 (13), p.1684-1689
• Main Authors: KREDIET, C. T, VAN DIJK, Nynke, LINZER, Mark, VAN LIESHOUT, Johannes J, WIELING, Wouter
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood Pressure; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Disease Management; Exercise Movement Techniques - methods; Female; Hand Strength; Heart Rate; Humans; Leg - innervation; Leg - physiopathology; Male; Medical sciences; Middle Aged; Muscle Contraction - physiology; Muscle, Skeletal - blood supply; Muscle, Skeletal - physiopathology; Nervous system (semeiology, syndromes); Neurology; Nitroglycerin; Posture; Reaction Time; Syncope, Vasovagal - physiopathology; Syncope, Vasovagal - prevention & control; Tilt-Table Test; Treatment Outcome; Vasodilator Agents
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000030939.12646.8F

Posture-related vasovagal syncope is by far the most frequent cause of transient loss of consciousness, and present pharmacological and cardiac pacing treatment remains unsatisfactory. A simple maneuver to prevent or diminish vasovagal reactions would be beneficial. Twenty-one patients with recurrent syncope (age 17 to 74 years, 11 males) who were referred for routine tilt-table testing and had a positive test were included. They were instructed to perform leg crossing and muscle tensing for at least 30 seconds at the onset of a tilt table-provoked impending faint. Continuously measured blood pressure and heart rate at nadir and during the maneuver were compared. Ten months after the test, a telephone follow-up was performed. The physical counter-maneuver, performed in 20 of 21 subjects, increased blood pressure and heart rate. Systolic blood pressure rose from 65+/-13 to 106+/-16 mm Hg (mean+/-SD, P