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(Circulation. 2004;109:e217.)
© 2004 American Heart Association, Inc.

Correspondence

Simple Self-Help Maneuvers Are Effective in Aborting Vasovagal Syncope

Tsung O. Cheng, MD

Professor of Medicine, George Washington University, Washington, DC

To the Editor:

The recent article by Lu et al¹ reminded us of the frequency of vasovagal syncope (neurally mediated syncope) in the general population—22%. Although effective therapy, both pharmacologically and with a pacemaker, is now available,² prevention is still the best recourse. Because vasovagal syncope is preceded by prodromal symptoms in two thirds of cases,³ there should be time to apply preventive measures.

Recently, it has been shown that such simple self-help maneuvers as isometric arm contraction⁴ and leg crossing and muscle tensing,⁵ all of which work by increasing systemic blood pressures, could either postpone or prevent vasovagal syncope. Additionally, water ingestion, as reported by Lu et al,¹ increases peripheral vascular resistance. The knowledge that such simple self-help maneuvers are readily available and could be lifesaving should prove valuable and helpful in everyday life. These self-help maneuvers are particularly relevant in preventing automobile accidents resulting from vasovagal syncope.⁶ As the saying goes, an ounce of prevention is worth a pound of cure.

References

1. Lu C-C, Diedrich A, Tung C-S, et al. Water ingestion as prophylaxis against syncope. Circulation. 2003; 108: 2660–2665.[Abstract/Free Full Text]
   
2. Kapoor WN. Is there an effective treatment for neurally mediated syncope? JAMA. 2003; 289: 2272–2275.[Free Full Text]
   
3. Alboni P, Brignole M, Menozzi C, et al. Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001; 37: 1921–1928.[Abstract/Free Full Text]
   
4. Brignole M, Croci F, Menozzi C, et al. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol. 2002; 40: 2053–2059.[Abstract/Free Full Text]
   
5. Krediet CTP, van Dijk N, Linzer M, et al. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002; 106: 1684–1689.[Abstract/Free Full Text]
   
6. Blitzer ML, Saliba BC, Ghantous AE, et al. Causes of impaired consciousness while driving a motorized vehicle. Am J Cardiol. 2003; 91: 1373–1374.[CrossRef][Medline] [Order article via Infotrieve]
   

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Response

Chih-Cherng Lu, MD; Che-Se Tung, MD, PhD

National Defense Medical Center, Taipei, Taiwan, ROC

André Diedrich, MD, PhD; Sachin Y. Paranjape, BS; Paul A. Harris, PhD; Daniel W. Byrne, MS; David Robertson, MD

Vanderbilt University School of Medicine, Nashville, Tenn

Jens Jordan, MD

Franz-Volhard Clinical Research Center, Medical Faculty of the Charite, Humboldt-University, Berlin, Germany

Dr Cheng is quite right in his comments on our article¹ about the value of simple measures in syncope. It is remarkable how simple lifestyle changes can elicit such dramatic effects in autonomic disorders and especially in autonomic failure.² Standing may lower blood pressure more than 50 mm Hg in such patients, whereas lying down may take a patient’s blood pressure up into the hypertensive range. The ingestion of food may lower blood pressure 30 mm Hg while the ingestion of 16 ounces of tap water may raise blood pressure by 40 mm Hg.³ Hyperventilation may lower blood pressure by 30 mm Hg, whereas hypoventilation may raise pressure 25 mm Hg.⁴ Exercise and straining, such as the Valsalva maneuver, significantly lower blood pressure, whereas immersion in water and the use of abdominal binding are pressor.⁵ Another remarkable effect is that conditions that elicit fever in normal individuals may more prominently lower blood pressure in autonomic failure patients and have less effect on temperature elevation. These observations indicate that patients with autonomic disorders have a large armamentarium of therapeutic maneuvers at their disposal. Careful application of these maneuvers can greatly enhance their ability to tolerate their illness.

References

1. Lu C-C, Diedrich A, Tung C-S, et al. Water ingestion as prophylaxis against syncope. Circulation. 2003; 108: 2660–2665.[Abstract/Free Full Text]
   
2. Shannon JR, Jordan J, Robertson D. Blood pressure in autonomic failure: drinks, meals, and other ordeals. Clin Sci. 1997; 94: 5.
   
3. Jordan J, Shannon JR, Grogan E, et al. A potent pressor reflex elicited by drinking water. Lancet. 1999; 353: 723.[CrossRef][Medline] [Order article via Infotrieve]
   
4. Onrot J, Bernard G, Biaggioni I, et al. Direct vasodilator effect of hyperventilation-induced hypocarbia in autonomic failure patients. Am J Med Sciences. 1991; 301: 305–309.[Medline] [Order article via Infotrieve]
   
5. Krediet CT, van Dijk N, Linzer M, et al. Management of vasovagal syncope: controlling or aborting faint by leg crossing and muscle tensing. Circulation. 2002; 106: 1684–1698.[Abstract/Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cheng, T. O. Articles by Jordan, J. Search for Related Content PubMed PubMed Citation Articles by Cheng, T. O. Articles by Jordan, J. Pubmed/NCBI databases Medline Plus Health Information Fainting Related Collections Autonomic, reflex, and neurohumoral control of circulation