Neurocardiogenic Syncope
Recurrent blackouts or faints cause great anxiety and interfere with normal living. There may be several reasons why these occur. However, despite intensive investigation the cause may remain elusive. Investigation is best carried out in a dedicated specialist clinic – often known as Syncope Clinic.
Cheltenham Syncope Clinic, a part of Gloucestershire Hospitals NHS Foundation Trust, was set up under Dr Deering’s leadership in 1992 and was one of the first Syncope Clinics in the UK.
Using state-of-the-art monitoring equipment the patient can be quickly investigated, diagnosed and treated. Full diagnostic facilities are available including 24h ECG, 7 day ECG, Cardiomemo, and 24h Ambulatory Blood Pressure Monitoring.
Tilt Table Testing and Carotid Sinus Massage are performed by medical staff and Cardiology Technicians, and there is access to Echocardiography, Exercise Tolerance Testing, Coronary angiography, Permanent Heart Pacemaker implantation, Reveal Recorder implantation, Carotid Doppler, CT scanning, MRI scanning, and EEG recording.
Neurocardiogenic Syncope is a common cause of previously unexplained blackouts. Carotid Sinus Syndrome, Orthostatic Hypotension, and cardiac dysrhythmias are other important causes. Prompt diagnosis and treatment can be very effective. Further detailed information on these conditions can be found at Syncope.co.uk, but it is worth highlighting the most common diagnosis – Neurocardiogenic Syncope.
Neurocardiogenic Syncope – one form of Vasovagal Syncope – may present for the first time at any age. It often occurs when upright, though can occur when sitting. It rarely occurs when lying. There often are no precipitating circumstances though attacks are more likely to occur in certain situations, for example during a large meal in a warm restaurant, when watching a production in a hot theatre, when flying in an aircraft, or after prolonged standing.
The onset may be abrupt or associated with prodromal fatigue, weakness, nausea, sweating, pallor, visual disturbance, abdominal discomfort, headache, pins-and-needles, light-headedness or vertigo. Presyncope may last for seconds or minutes. This prodromal phase may be absent in older individuals.
If syncope ensues, the individual usually lies still while unconscious, though occasionally s/he may convulse briefly. (Prolonged convulsions, blue face, or tongue biting at the time of collapse, and prolonged confusion and aching muscles afterwards help distinguish a true primary seizure from one secondary to vasovagal syncope. Sleepiness and urinary incontinence are of less value in making the distinction).
On recovery of consciousness the person may complain of nausea, clamminess, light-headedness, headache and malaise and may be unable to stand up for several minutes. Full recovery may take some hours.
Tilt Table Testing is the definitive investigation for Neurocardiogenic Syncope.
Reassurance about the benign nature of Neurocardiogenic Syncope, avoidance of situations likely to induce an attack, and use of simple non-drug counter-measures is often all that is required in the management of the condition. However, treatment with low dose medication may be necessary. Occasionally pacemaker implantation may be required. For further information visit Syncope.co.uk