Page 20 - Clinical Pearls in Cardiology

8 Clinical Pearls in Cardiology

In contrast, patients with vasovagal syncope often feel
nauseated and lightheaded and may have diaphoresis
and epigastric discomfort for several minutes before the
syncopal attack (prominent premonitory symptoms) and
recovery may take between 1 to 5 minutes. Vasovagal
syncope is caused by an abnormal or exaggerated
autonomic response to various stimuli, of which the
most common are prolonged standing and emotion.
The mechanism is poorly understood but involves
reflex mediated changes in heart rate or vascular tone,
caused by activation of the cardiac C fibers, resulting in
bradycardia and hypotension.
Patients with seizures may exhibit aura, and they are
often cyanosed and may have abnormal movements
during the period of unconsciousness. They usually
take more than 5 minutes to recover and are often
confused on recovery. They may have headache and
focal neurological signs (e.g. Todd’s palsy) during the
postictal period (Table 1).
Table 1: Difference between cardiac syncope, vasovagal syncope
and seizure
Cardiac syncope Vasovagal syncope Seizure
No premonitory Prominent Aura may be present
symptoms premonitory
symptoms
Can occur in any Occurs in the Can occur in any position
position standing position
Rare tonic clonic No tonic clonic Tonic clonic movements
movements movements and tongue bite usually
present
Recovery within Recovery within Recovery takes
1 minute 1 to 5 minutes >5 minutes
No confusion on No confusion on Postictal confusion
recovery recovery present