© 2003 by European Society of Cardiology
IMAGES IN CLINICAL ELECTROPHYSIOLOGY
Manoeuvres to combat vasovagal syncope
Department of Internal Medicine, Academic Medical Center, University of Amsterdam The Netherlands
Manuscript submitted 23 December 2002. Accepted after revision 12 April 2003.
Correspondence: W. Wieling, Department of Internal Medicine, Academic Medical Center, F4-221, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. Tel: +31-20-5665990; Fax: +31-20-6914904; E-mail: w.weiling{at}amc.uva.nl
A 32-year-old female patient underwent cardiovascular reflex assessment for recurrent syncope and pre-syncope, clinically of vasovagal origin. A vasovagal reaction, with prodromal pallor and sweating, occurred while the patient was standing motionless in the cardiovascular laboratory. The patient sat down on a chair with her head between her knees (Fig. 1A). After standing up, the hypotension returned and the patient squatted (Fig. 1B). After standing up, when hypotension returned again, she was instructed to cross her legs and tense leg, buttock and abdominal muscles (Fig. 1C), which successfully aborted the pre-syncope.
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Sitting down with head bent between the knees is the classical counter manoeuvre[1]
to combat vasovagal (pre-) syncope. Squatting and leg crossing combined with muscle tension[2] are recently introduced combative manoeuvers. The stabilizing effects on blood pressure of the manoeuvres are caused by increasing central venous pressure and refilling of the heart by mechanical pressure on the splanchnic veins (Fig. 1A) and activation of the muscle pump (Fig. 1B, C). References
[1] van Lieshout JJ, Wieling W, Karemaker JM, Eckberg DL. The vasovagal response. Clin Sci (Lond) 1991; 81:5 575–586.[Medline]
[2] Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation 2002; 106:13 1684–1689.
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