Confounders of Vasovagal Syncope
Open accessAbstract
Most patients who present to a cardiologist with syncope have vasovagal (reflex) syncope. A busy syncope practice often also sees patients with postural tachycardia syndrome, often presenting with severe recurrent presyncope. Recognition of this syncope confounder might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. Postural tachycardia syndrome can often be differentiated from vasovagal syncope by its hemodynamic pattern during tilt table test and differing clinical characteristics. This article reviews the presentation of postural tachycardia syndrome and its putative pathophysiology and presents an approach to nonpharmacologic and pharmacologic management.
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DDAVP can lead to hyponatremia.
“Although DDAVP reduces tachycardia and symptoms [72;71], it can lead to hyponatremia.”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [71]
Fludrocortisone can worsen migraine headaches.
“Fludrocortisone also stimulates potassium excretion, making it necessary to watch for hypokalemia, and it can also worsen migraine headaches [71;19].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [71]
DDAVP reduces tachycardia and symptoms in POTS.
“Although DDAVP reduces tachycardia and symptoms [72;71], it can lead to hyponatremia.”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [71]
Fludrocortisone stimulates potassium excretion, requiring monitoring for hypokalemia.
“Fludrocortisone also stimulates potassium excretion, making it necessary to watch for hypokalemia, and it can also worsen migraine headaches [71;19].”
From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [71]
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- [27]Raj SR Sheldon RS Saksena S Camm AJ Head-up tilt-table test Electrophysiological Disorders of the Heart 2012 73-1 73-11 Saunders New York 2nd ed
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- Authors
- Nwazue, V. C., & Raj, S. R.
- Affiliations
- Vanderbilt University (US)
- Corresponding author
- Raj, Satish R.
- ORCID
- Raj, Satish R.
- Venue
- Cardiology Clinics
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 31
- Issue
- 1
- Pages
- 101-109
- ISSN
- 0733-8651 (ISSN-L)
- PMC
- PMC3522867
- OpenAlex
- W1558442418
- Cited by
- 23
- References
- 26
- Citations by year
- 2025: 3 · 2024: 2 · 2022: 4 · 2021: 1 · 2017: 4 · 2016: 3 · 2015: 3 · 2014: 3
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cardiology Clinics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000445)
- National Heart, Lung, and Blood Institute (R01HL071784, P01HL056693, R01HL102387, P01 HL-56693)
- National Institute of Neurological Disorders and Stroke (U54NS065736)
- National Center for Research Resources (KL2RR024977, TL1RR024978, UL1RR024975)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- vasovagal syncope, reflex syncope, postural orthostatic tachycardia syndrome, tilt table test, hemodynamic patterns, presyncope, pathophysiology, non-pharmacological treatment, pharmacological management
- MeSH terms
- Aged, Aged, 80 and over, Echocardiography, Electrocardiography, Exercise Test, Hemodynamics, Humans, Middle Aged, Tilt-Table Test, Syncope, Vasovagal, Postural Orthostatic Tachycardia Syndrome
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