What is Vasovagal Episode?
Vasovagal syncope, or a ‘vasovagal episode’, refers to a common kind of fainting spell often caused by a temporary malfunction in the body’s blood pressure regulation. In simpler terms, this occurs when your body doesn’t adjust properly to changes in blood pressure, causing less blood to reach your brain and making you pass out briefly. The process behind this is somewhat complex, involving potential decreases in both heart function and blood vessel activity.
It’s worth noting that vasovagal syncope is an example of ‘reflex syncope’, a term for fainting spells that come from similar issues with blood pressure regulation. There are other types of reflex syncope too, such as carotid sinus syncope (caused by pressure on your neck) or situational syncope (which can occur from triggers like a severe cough or using the washroom). Triggers for vasovagal syncope can vary, and they often involve intense pain or emotional distress. However, sometimes a specific cause can’t be pinpointed.
What Causes Vasovagal Episode?
The exact cause of vasovagal syncope, which is a type of fainting, isn’t clear. Some people think that it’s an overreaction of the body’s natural response to help with blood clotting during injury. To put it simply, when you’re hurt, your body may react by lowering your blood pressure and heartbeat to lessen bleeding. Some experts are also exploring if it is somehow linked to genetics.
Genetic research about vasovagal syncope is challenging due to many people being affected by it. However, studies examining DNA have shown some differences in families who frequently experience fainting. Therefore, more research into this area is encouraged.
Risk Factors and Frequency for Vasovagal Episode
Vasovagal syncope, which is a common type of fainting experienced by adults, accounts for over 85% of fainting episodes in individuals below the age of 40. This remains the case even for older people, with over half of fainting episodes in this group also due to vasovagal syncope. This condition needs a healthy and properly functioning autonomic nervous system to occur, so it’s not common in groups where this system is dysfunctional, like those suffering from Parkinson’s disease. Over one-third of people are likely to experience a vasovagal syncope episode in their lifetime.
Signs and Symptoms of Vasovagal Episode
Syncope, commonly known as fainting, can be caused by a number of different conditions. These include heart rhythm disorders, sudden blood loss, seizure, low blood pressure when standing up, dehydration, ruptured blood vessels, bleeding into the brain, blood clots in the lungs, ectopic pregnancy complications, head injury, toxins, and many others. When doctors check for causes of syncope, they first rule out any life-threatening reasons before diagnosing it as vasovagal syncope, which is a common type of fainting. They look into the patient’s personal and family history of heart disease, check for possible blood loss in the stomach or urinary tract, and consider whether any medications, like blood pressure medications, antihistamines, anticholinergic drugs, and blood thinners, could be causing the fainting.
- Family and personal history of heart disease
- Potential for blood loss in the stomach or urinary tract
- Use of medications such as blood pressure medications, antihistamines, anticholinergic drugs, and blood thinners
People with vasovagal syncope often experience a warning sign before fainting. These signs can include feeling lightheaded, warm, and nauseous. Some people may also experience changes in vision, ringing in their ears, and excessive sweating. Usually, the person’s heart rate and blood pressure will drop, their skin might turn pale, and they may sweat a lot during the fainting episode. They should wake up on their own and appear completely normal after the event. However, if there are any signs of injury, such as a bitten tongue, or the person’s skin remains pale, the doctor will need to investigate further for the underlying cause of the fainting.
Testing for Vasovagal Episode
If you go to the doctor due to fainting, they will usually conduct a comprehensive examination and ask for details about your medical history. They will check for paleness, heart issues (like unusual heart sounds, too fast or too slow heart rates, and irregular heartbeat), lung problems, and any signs of injury. Depending on the situation, they might also arrange for X-rays to check for injuries you may have got when you fainted.
Regardless of why you fainted, your doctor will want to do an EKG, which is a test that checks how your heart is working. This is to see if you have any heart conditions that might have caused the fainting, such as Wolff-Parkinson-White syndrome, prolonged QT syndrome, Brugada syndrome, or heart blocks. If you’re a woman who could be pregnant, they’ll also do a pregnancy test. If they suspect you’re fainting because of blood loss, they may do a fecal blood test, which checks for blood in your stool that you can’t see with your eyes.
The next steps for investigating why you fainted can depend on the specifics of your case and any other health conditions you might have. For someone who’s otherwise healthy and who’s fainted in a way that matches a widely-known condition called vasovagal syncope, there’s typically no need for further tests if an EKG comes back normal. However, if it’s not clear why you’ve fainted or if there could be more than one reason for it, they might want to run some other tests, including ones that check your blood’s salt levels, cell counts, and if there are any markers of heart damage in your blood.
If you keep fainting or if it’s still not clear why it’s happening, your doctor might ask you to wear a Holter monitor or an event monitor. These are devices that can record your heart’s activity over a longer period of time. They could also ask you to do a tilt table test, which helps to understand how your body responds to changes in position and could clarify why you’re fainting. These tests are usually done outside of a hospital setting.
Treatment Options for Vasovagal Episode
Vasovagal syncope, also known as fainting, is usually treated with simple methods. This can include avoiding things that are known to trigger a fainting spell, where possible. Patients are often advised to increase their fluid intake, to boost the volume of blood in their body, and to make sure to stand up or change position slowly.
They also learn about the warning signs of an impending fainting episode, and are instructed to lie down if they feel an episode starting. This not only often prevents the fainting spell from actually happening, but it also lessens the risk of injuries from falling over.
If these simple methods aren’t enough, or if the patient has a particularly serious form of vasovagal syncope that leads to prolonged periods of a very slow heartbeat (known as asystole), a cardiac pacemaker may be an option for treatment. This is a device that helps control abnormal heart rhythms.
What else can Vasovagal Episode be?
There are several possible causes for your symptoms, which could include:
- Dehydration
- Diabetic nerve damage, also known as diabetic neuropathy
- Intense urination, a condition called diuresis
- Low blood pressure caused by certain medicines, known as drug-induced orthostasis
- Dysfunction in the autonomic nervous system, or dysautonomia
- Pregnancy outside of uterus, known as ectopic pregnancy
- Heavy bleeding, or haemorrhage
- Low blood pressure, or hypotension
- Reduced volume of blood in the body, a condition called hypovolemia
- A serious neurological disorder called multisystem atrophy
- Disease of peripheral nerves, also known as peripheral polyneuropathy
- Drop in blood pressure when standing, known as postural hypotension
- Redirection of blood flow around blocked arteries in the neck, a condition called subclavian steal
- Inability of blood vessels to narrow and uphold the blood pressure, a phenomenon termed as vasomotor insufficiency
