Nonpharmacological treatment of reflex syncope.

Reflex syncope is a common medical problem. Vasovagal reflex syncope is the most frequent form. Although the prognosis of the disorder is excellent, it may impose substantial changes in life style and cause profound psychological distress. Thus, management of this disorder is an important issue. This chapter, based on a review of the literature and the authors' clinical experience, encompasses the non-pharmacological measures used in the management of reflex syncope. The cornerstone of the non-pharmacological management of patients with reflex syncope is education and reassurance regarding the benign nature of the condition. Patients should be instructed to avoid potential triggers. A tilt table test can be employed to teach the patient to recognize early premonitory symptoms. There are several physical maneuvers (e. g., leg crossing, muscle tensing and squatting) that are effective in combating orthostatic intolerance. For the majority of patients this approach is adequate. Patients with frequent attacks of reflex syncope are advised to increase their dietary salt intake. Exercise training also increases orthostatic tolerance. In highly motivated patients with recurrent syncope, raising the head of the bed to permit gravitational exposure during sleep and prolonged periods of enforced maintenance of the upright posture (tilt-training) can be considered. Preliminary data suggest that water drinking may improve orthostatic tolerance. Abdominal belts may also be effective in highly symptomatic subjects with reflex syncope.