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Neurogenic fainting in itself is not fatal, treatment involving medication but resulting falls can be harmful, examples are fainting episodes in swimming and downhill skiing that resulted in serious injuries.

What types of therapy are used to treat fainting spells?

The treatment of a patient with syncope depends entirely on the cause. Every cause of syncope has an effective treatment, but given the large number of causes of syncope, there are a large number of different treatments. For example, therapy may be as simple as a change in diet or a daily medication. Some patients may require a pacemaker or surgery.

Urgent treatment at the time of fainting: Non-drug therapy Other Options Drug therapy

The following drugs are used to treat Syncope:

Beta-blockers are commonly used to treat vasovagal syncope. Though it seems paradoxical to select a negatively chronotropic medication to treat bradycardia, the negative inotropic effects may decrease the afferent signals from the mechanoreceptors to the brain stem, thereby suppressing the efferent arm of the reflex.

Disopyramide has been used successfully in the treatment of neurally mediated syncope. This type 1 antiarrhythmic has profound negative inotropic effects and anticholinergic properties. The negative inotropic effects may decrease afferent mechanoreceptor activity, while the anticholinergic effects may decrease vagal (efferent) output.

Selective Serotonin Reuptake Inhibitors (SSRIs) have also been used with success in patients who have vasovagal syncope, though the mechanism of action is speculative. A study has shown that intracerebroventricular serotonin induces hypotension, inhibits renal sympathetics, and excites adrenal sympathetics. SSRIs may blunt the response to shifts in serotonin levels.

Fludrocortisone Acetete, which has volume-expanding properties, has been used with some success.

Midodrine, which received US Food and Drug Administration approval in September 1996 for the treatment of orthostatic hypotension, has peripheral alpha-adrenergic effects and has shown promise in treating vasovagal reactions.

Special Considerations for Athletes

Compared to nonathletes, athletes require greater care in choosing medications. Depending on the individual and the activity involved, medication may either blunt performance and be deemed intolerable, or enhance performance and be banned by sports governing bodies.

  • Beta-blockers may negatively affect performance to varying degrees and are prohibited in certain sports. In shooting sports, the beta-blockers are restricted because bradycardia and muscle tremor suppression may enhance accuracy.
  • Disopyramide has significant negative inotropic effects that decrease cardiac output. SSRIs do not affect cardiac output and appear to be a wise choice in athletes; however, these agents may increase brain levels of serotonin, a substance that may lead to earlier fatigue. Two human studies found a positive correlation between SSRIs and fatigue.
  • Fludrocortisone does not have any performance-impairing properties except for a potential increase in body weight and blood pressure.
  • Midodrine is not yet listed with the US Olympic Committee (USOC) but will almost certainly be banned because of its stimulant properties. For those athletes who participate in activities not governed by the USOC, midodrine may be a good choice because it does not impair performance.

The following chart shows medication Options for Treating Active People With Syncope:

Drug Effect on Exercise Effect on Drug Testing
Beta-Blockers Bradycardia can impair aerobic performance, suppress muscle tremor Banned in shooting sports
Disopyramide Phosphate May decrease cardiac output, which may lead to impaired aerobic performance None
Selective Serotonin Reuptake Inhibitors Might lead to earlier fatigue None
Fludrocortisone Acetate Potential increase in body weight and blood pressure None
Midodrine Hydrochloride None known May be banned for stimulant properties by the International Olympic Committee

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Children's Heart Institute

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