Pharmacological treatment of reflex syncope.
Patient education, identification of possible triggers of syncope and reassurance are a central feature of the management of patients with reflex syncope. Patients should be advised as to the importance of adequate hydration and taught physical countermaneuvers to enhance cardiac venous return. These maneuvers are sufficient for most patients, however, for a small number of patients who continue to have recurrent syncopal events, pharmacological intervention may be considered. Volume expansion can be enhanced with salt and fludrocortisone. Agents from diverse pharmacological classes have been used to attenuate the reflex response, enhance vasoconstriction and attenuate vagal outflow. Alpha adrenoreceptor agonists, anticholinergic agents, theophylline, beta adrenoreceptor antagonists, serotonin reuptake inhibitors and disopyramide are the most widely studied. None of these agents has shown a consistent therapeutic benefit in clinical trials.
Mount Sinai School of Medicine, Box 1052, New York, NY 10029, USA. horacio.kaufmann@mssm.edu.
Horacio
H
Kaufmann
Roy
R
Freeman
D018663:Adrenergic Agents / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D004206:Disopyramide / Q000627:therapeutic use; D006801:Humans; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D019462:Syncope, Vasovagal / Q000188:drug therapy*; D013806:Theophylline / Q000627:therapeutic use
D018663:Adrenergic Agents; D000889:Anti-Arrhythmia Agents; D018680:Cholinergic Antagonists; D020845:Selective Estrogen Receptor Modulators; D013806:Theophylline; D004206:Disopyramide