Important aspects in the management of neurocardiogenic syncope

Important aspects in the management of neurocardiogenic syncope Neurocardiogenic syncope is the most common cause of syncope. Initial measures in management include lifestyle modifications, increasing the fluid and salt intake and education about physical counterpressure methods. Pharmacological measures may be tried next. Pacemaker implantation has been tried in those with predominantly cardioinhibitory syncope [1]. Physical counterpressure measures are movements like leg crossing and hand gripping which may prevent loss of consciousness in those who feel the presyncopal symptoms. These measures increase the systemic vascular resistance and blood pressure to counter the vasodepressive element of neurocardiogenic syncope. An important limitation of physical counterpressure measures is that they can be applied by only those who have prodromal symptoms. Important pharmacological agents which have been tried in the management of neurocardiogenic syncope are midodrine, beta blockers, paroxetine and fludrocortisone. Midodrine has been given a Class II recommendation in the management of neurocardiogenic syncope. Beta blockers may have some benefit in those above 40 years and has been given a Class IIb recommendation. But it may be harmful in those below 42 years, as noted in an analysis of the randomized Prevention of Syncope Trial (POST) [2]. POST5 is evaluating the role of metoprolol in those aged 40 years or more. It is a multicenter, international randomized placebo controlled...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs