Vasovagal Syncope Countermeasure Handout
Immediate Actions During Warning Signs
If you feel warning signs (lightheadedness, sweating, nausea, vision changes), immediately sit or lie down to prevent injury. 1
Physical Counterpressure Maneuvers (Most Important)
Physical counterpressure maneuvers are the most effective immediate intervention and should be taught to all patients with adequate warning symptoms. 1, 2
Perform these maneuvers as soon as you feel symptoms:
- Leg crossing with muscle tensing: Cross your legs and tense leg, abdominal, and buttock muscles simultaneously while standing or lying down 1
- Squatting: Lower into a full squat position and hold, tensing leg and abdominal muscles 1
- Isometric arm contraction: Grip your hands together with fingers interlocked and pull arms in opposite directions with maximum force 1
- Handgrip: Clench your fist at maximum contraction, with or without holding an object 1
These maneuvers increase blood pressure by 20-40 mmHg and can abort or delay loss of consciousness. 1, 2 In randomized trials, leg crossing with muscle tensing reduced syncope recurrence significantly compared to standard care alone. 1
Daily Prevention Strategies
Dietary Modifications (First-Line)
Increase salt intake to 6-10 grams daily and fluid intake to 2-2.5 liters per day unless you have hypertension, heart failure, or kidney disease. 1
- Use salt tablets or sports drinks for electrolyte supplementation 1
- Eat frequent small meals with reduced carbohydrate content 1
Trigger Avoidance (Essential)
Avoid or minimize exposure to known triggers: 1, 2
- Prolonged standing (shift weight, move legs frequently)
- Hot, crowded, or confined environments
- Dehydration
- Blood draws and medical procedures (lie down during these)
- Emotional stress
- Alcohol consumption
- Sudden postural changes
Compression Garments
Wear waist-high compression stockings (30-40 mmHg) or abdominal binders to reduce venous pooling. 1
Exercise and Conditioning
Engage in moderate exercise training, particularly swimming and leg/abdominal muscle exercises. 1
Sleep Position
Elevate the head of your bed by 10-20 degrees using blocks under the bed frame. 1
Medication Review
Review all medications with your physician and discontinue or reduce doses of blood pressure-lowering drugs when appropriate. 1
Common culprits include:
- Diuretics
- Alpha-blockers
- Vasodilators
- Antihypertensives
When to Seek Medical Attention
Contact your physician if:
- Episodes become more frequent or severe
- You experience syncope without warning symptoms
- You sustain injuries from falls
- Episodes occur during exertion or while lying down (these may indicate cardiac causes)
Important Safety Information
- Never drive or operate machinery if you have frequent unpredictable episodes 1, 2
- Avoid activities where sudden loss of consciousness could cause serious injury (climbing ladders, swimming alone, operating heavy equipment) 1, 2
- Take your last medication dose 3-4 hours before bedtime if prescribed midodrine to avoid supine hypertension 3
Prognosis
Vasovagal syncope is not life-threatening and has an excellent prognosis. 1, 2, 4 Most patients experience improvement over time with proper management, and many eventually stop having episodes. 5 Quality of life improves significantly with education and implementation of these countermeasures. 1, 5
Key Points to Remember
- Physical counterpressure maneuvers work best when you have at least 5-10 seconds of warning symptoms
- Salt and fluid loading takes 1-2 weeks to show full effect
- Consistency with preventive measures is more important than any single intervention
- Most patients do not require medication if they follow these recommendations 2, 4, 5