Vasovagal Syncope: Current Concepts of Pathogenesis, Diagnosis and Clinical Significance

Abstract

Background: Vasovagal syncope (VVS) is a common cause of transient loss of consciousness, particularly among young adults. Its diagnosis remains challenging because of overlapping manifestations with cardiac, neurological and functional disorders. This study aimed to evaluate diagnostic approaches, haemodynamic characteristics and preventive strategies in patients with suspected VVS. Materials and Methods: Clinical and instrumental findings were analysed in 78 patients with recurrent transient loss of consciousness, including 69 women (88.5%). Assessment comprised clinical history, neurological and cardiovascular examinations, electrocardiography, orthostatic testing and, where indicated, head-up tilt testing, ambulatory ECG monitoring, echocardiography and electroencephalography. Recurrence frequency, precipitating factors and preventive interventions were evaluated. Results: VVS was confirmed in 57 patients (73.1%), functional disorders in 8 (10.3%), epilepsy in 3 (3.8%) and cardiac causes in 7 (9.0%); the aetiology remained undetermined in 3 (3.8%). Annual syncope frequency was 3 [2; 5] episodes in VVS versus 2 [1; 4] in other diagnostic groups (p = 0.13). During active standing, heart rate increased by 18 [12; 25] versus 12 [8; 18] beats/min (p = 0.028), while systolic blood pressure decreased by 16 [10; 23] versus 8 [5; 14] mmHg (p = 0.005). Head-up tilt testing demonstrated greater hypotensive responses in VVS (p < 0.001). Coughing was identified as a potential situational trigger requiring separate diagnostic consideration. Conclusions: Accurate VVS diagnosis requires integrated clinical and haemodynamic assessment and exclusion of potentially serious alternative causes. Individualised trigger management, physical counter-pressure manoeuvres and appropriate preventive interventions are important components of patient care.