title: Confounders of vasovagal syncope: orthostatic hypotension.
abstract: A syncope evaluation should start by identifying potentially life-threatening causes, including valvular heart disease, cardiomyopathies, and arrhythmias. Most patients who present with syncope, however, have the more benign vasovagal (reflex) syncope. A busy syncope practice often also sees patients with neurogenic orthostatic hypotension presenting with syncope or severe recurrent presyncope. Recognition of these potential confounders of syncope might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. This article reviews the presentation of the vasovagal syncope confounder and the putative pathophysiology of orthostatic hypotension, and suggests options for nonpharmacologic and pharmacologic management.
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University School of Medicine, AA3228 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2195, USA.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Nwazue
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000150:complications*; D017704:Baroreflex / Q000502:physiology; D003937:Diagnosis, Differential; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010300:Parkinson Disease / Q000175:diagnosis; D011187:Posture / Q000502:physiology; D054970:Pure Autonomic Failure / Q000150:complications / Q000175:diagnosis; D012791:Shy-Drager Syndrome / Q000150:complications / Q000175:diagnosis; D019462:Syncope, Vasovagal / Q000209:etiology*; D018667:Tilt-Table Test; D014636:Valsalva Maneuver / Q000502:physiology