title: Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing.
abstract: BACKGROUND
  Posture-related vasovagal syncope is by far the most frequent cause of transient loss of consciousness, and present pharmacological and cardiac pacing treatment remains unsatisfactory. A simple maneuver to prevent or diminish vasovagal reactions would be beneficial.
  
  
  RESULTS
  Twenty-one patients with recurrent syncope (age 17 to 74 years, 11 males) who were referred for routine tilt-table testing and had a positive test were included. They were instructed to perform leg crossing and muscle tensing for at least 30 seconds at the onset of a tilt table-provoked impending faint. Continuously measured blood pressure and heart rate at nadir and during the maneuver were compared. Ten months after the test, a telephone follow-up was performed. The physical counter-maneuver, performed in 20 of 21 subjects, increased blood pressure and heart rate. Systolic blood pressure rose from 65+/-13 to 106+/-16 mm Hg (mean+/-SD, P<0.001), and diastolic blood pressure rose from 43+/-9 to 65+/-10 mm Hg (P<0.001). During the maneuver, prodromal symptoms disappeared in all patients, and none lost consciousness. After terminating the maneuver, symptoms did not return in 5 subjects during the test. At follow-up, 13 of 20 patients reported that they applied the maneuver in daily life and benefited from it.
  
  
  CONCLUSIONS
  Leg crossing combined with tensing muscles at the onset of prodromal symptoms can postpone and in some subjects prevent vasovagal syncope.
authors.affiliation: Department of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: C T Paul
authors.initials: CT
authors.lastname: Krediet
authors.forename: Nynke
authors.initials: N
authors.lastname: van Dijk
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: van Lieshout
authors.forename: Wouter
authors.initials: W
authors.lastname: Wieling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure; D019468:Disease Management; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006339:Heart Rate; D006801:Humans; D007866:Leg / Q000294:innervation / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*; D018482:Muscle, Skeletal / Q000098:blood supply / Q000503:physiopathology; D005996:Nitroglycerin; D011187:Posture; D011930:Reaction Time; D019462:Syncope, Vasovagal / Q000503:physiopathology* / Q000517:prevention & control*; D018667:Tilt-Table Test; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin