From the Guidelines
If you experience presyncope, sit or lie down immediately and elevate your legs to improve blood flow to your brain, and consider using physical counterpressure maneuvers (PCMs) like crossing legs while tensing muscles to help prevent episodes. Presyncope is a feeling of lightheadedness or dizziness that suggests you might faint but don't actually lose consciousness. It's often caused by temporary insufficient blood flow to the brain. Some key points to consider when managing presyncope include:
- Identifying and avoiding triggers such as prolonged standing, hot environments, dehydration, or certain medications 1
- Staying well-hydrated by drinking 2-3 liters of water daily and increasing salt intake slightly (unless contraindicated by other medical conditions)
- Using PCMs like crossing legs while tensing muscles or squeezing a rubber ball to help prevent episodes when you feel symptoms beginning 1
- Consulting a healthcare provider if presyncope occurs frequently, as it may indicate underlying conditions like cardiac arrhythmias, structural heart disease, or orthostatic hypotension 1
- Considering medications such as fludrocortisone (0.1-0.2 mg daily) or midodrine (2.5-10 mg three times daily) for recurrent cases, as recommended by recent guidelines 1 Presyncope occurs because of momentary drops in blood pressure or heart rate that reduce cerebral perfusion, often triggered by autonomic nervous system imbalances or volume depletion 1. Recent guidelines from 2024 emphasize the importance of recognizing presyncope and using PCMs to prevent syncope, highlighting the potential benefits of early intervention in reducing the risk of injury and improving outcomes 1.
From the Research
Definition and Classification of Presyncope
- Presyncope is a condition that precedes syncope, characterized by a transient loss of consciousness caused by cerebral hypoperfusion 2
- It is classified into three main types: reflex syncope, syncope due to orthostatic hypotension, and cardiac syncope 3
Causes and Risk Factors of Presyncope
- Orthostatic hypotension is a common cause of presyncope, which can be detected by performing an orthostatic challenge with active standing 3
- Aging, diabetes, and Parkinson's disease are associated with an increased risk of orthostatic hypotension, which can lead to presyncope 4
- Other risk factors include dehydration, medication, and certain medical conditions 2
Diagnosis and Evaluation of Presyncope
- A standardized approach to syncope evaluation, including a detailed history, physical examination, and electrocardiography, can reduce hospital admissions and medical costs, and increase diagnostic accuracy 2
- Laboratory testing and neuroimaging have a low diagnostic yield and should be ordered only if clinically indicated 2
- Clinical decision rules can be used to assess the short-term risk of death and the need for hospital admission 2
Treatment and Management of Presyncope
- Physical counter-pressure maneuvers (PCM) may provide benefit for prevention of syncope during acute episodes of presyncope and may be tried in the first aid setting 5
- Simple measures, such as changing body position and increasing fluid intake, can reduce the recurrence of presyncope 3
- Pharmacological interventions, such as fludrocortisone and midodrine, may be necessary in some cases, especially for patients with orthostatic hypotension 4, 6