Management of Reflex Syncope : Non-Pharmacological and Pharmacological
Rivasi, Giulia and Fedorowski, Artur LU
(2024)
p.135-141
- Abstract
Non-pharmacological interventions represent the first-line treatment approach for patients with non-cardiac syncope. These interventions include reassurance of the benign nature of syncope, education about triggers and strategies to avoid them, early recognition of prodromal symptoms, and lifestyle measures to counteract blood pressure falls. Adequate water intake is recommended to avoid hypovolemia, and a water bolus may be helpful to prevent hypotension in predisposing conditions. Physical counterpressure maneuvers (i.e., leg-crossing, arm tensing, and hand-gripping) might allow to abort syncope during prodromal symptoms and are also helpful as preventive measures in triggering situations. Post-prandial hypotension can be minimized by... (More)
Non-pharmacological interventions represent the first-line treatment approach for patients with non-cardiac syncope. These interventions include reassurance of the benign nature of syncope, education about triggers and strategies to avoid them, early recognition of prodromal symptoms, and lifestyle measures to counteract blood pressure falls. Adequate water intake is recommended to avoid hypovolemia, and a water bolus may be helpful to prevent hypotension in predisposing conditions. Physical counterpressure maneuvers (i.e., leg-crossing, arm tensing, and hand-gripping) might allow to abort syncope during prodromal symptoms and are also helpful as preventive measures in triggering situations. Post-prandial hypotension can be minimized by eating smaller and more frequent meals with low carbohydrate content. Additional lifestyle measures include the use of compressive garments, lower body muscle strengthening, and head-up sleeping in patients with orthostatic hypotension. As intensive BP control is known to increase the risk of syncope, reduction/withdrawal of hypotensive medications may be indicated, targeting a systolic blood pressure of 130-140 mmHg. Higher targets may be advisable in older patients at risk of falls. Pharmacological treatment options including fludrocortisone, midodrine, droxidopa, and norepinephrine transporter inhibitors can be considered if symptoms persist despite optimal non-pharmacological treatment and medication review.
(Less)
- author
- Rivasi, Giulia
and Fedorowski, Artur
LU
- organization
- publishing date
- 2024-10-24
- type
- Chapter in Book/Report/Conference proceeding
- publication status
- published
- subject
- host publication
- Syncope : From Etiopathogenesis to New Therapeutic Options - From Etiopathogenesis to New Therapeutic Options
- editor
- Aksu, Tolga and Morillo, Carlos A.
- pages
- 7 pages
- publisher
- CRC Press
- external identifiers
-
- scopus:85207531880
- ISBN
- 9781032542348
- 9781040123713
- DOI
- 10.1201/9781003415855-18
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2025 selection and editorial matter, Tolga Aksu and Carlos A. Morillo individual chapters, the contributors.
- id
- c4d85959-ca9f-49b6-af58-ff80c37a1e4e
- date added to LUP
- 2024-11-11 14:52:49
- date last changed
- 2025-07-22 11:13:45
@inbook{c4d85959-ca9f-49b6-af58-ff80c37a1e4e,
abstract = {{<p>Non-pharmacological interventions represent the first-line treatment approach for patients with non-cardiac syncope. These interventions include reassurance of the benign nature of syncope, education about triggers and strategies to avoid them, early recognition of prodromal symptoms, and lifestyle measures to counteract blood pressure falls. Adequate water intake is recommended to avoid hypovolemia, and a water bolus may be helpful to prevent hypotension in predisposing conditions. Physical counterpressure maneuvers (i.e., leg-crossing, arm tensing, and hand-gripping) might allow to abort syncope during prodromal symptoms and are also helpful as preventive measures in triggering situations. Post-prandial hypotension can be minimized by eating smaller and more frequent meals with low carbohydrate content. Additional lifestyle measures include the use of compressive garments, lower body muscle strengthening, and head-up sleeping in patients with orthostatic hypotension. As intensive BP control is known to increase the risk of syncope, reduction/withdrawal of hypotensive medications may be indicated, targeting a systolic blood pressure of 130-140 mmHg. Higher targets may be advisable in older patients at risk of falls. Pharmacological treatment options including fludrocortisone, midodrine, droxidopa, and norepinephrine transporter inhibitors can be considered if symptoms persist despite optimal non-pharmacological treatment and medication review.</p>}},
author = {{Rivasi, Giulia and Fedorowski, Artur}},
booktitle = {{Syncope : From Etiopathogenesis to New Therapeutic Options}},
editor = {{Aksu, Tolga and Morillo, Carlos A.}},
isbn = {{9781032542348}},
language = {{eng}},
month = {{10}},
pages = {{135--141}},
publisher = {{CRC Press}},
title = {{Management of Reflex Syncope : Non-Pharmacological and Pharmacological}},
url = {{http://dx.doi.org/10.1201/9781003415855-18}},
doi = {{10.1201/9781003415855-18}},
year = {{2024}},
}