Vasovagal syncope
ICD-10 R55 · ICD-11 MG45.Z

Vasovagal Syncope Persisting After Education and Lifestyle Modifications

When initial education and lifestyle measures have been applied but syncopal episodes continue to recur, a next-line approach is needed to further reduce the syncope burden.

Previous treatment line — target not met

Education and Lifestyle Modifications

This first-line approach encompassed explanation of the diagnosis and its benign nature, trigger recognition and avoidance (including dehydration and hot crowded environments), increased oral fluid intake, salt supplementation, and — where applicable — adjustment of any hypotensive drug regimen.

Goal not reached: Reduction of syncopal recurrences (decrease of the syncope burden).
Next-line approach

Physical Counter-Pressure and Behavioural Interventions

The next step centres on physical counter-pressure manoeuvres performed at the onset of prodromal symptoms, indicated for a specific patient sub-group. Additional behavioural interventions are part of the evidence-based options for eligible younger patients.

The complete protocol — including which interventions apply, their indications, and how they are sequenced — is in the full regimen.

Goal: reduction of syncopal recurrences
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehy037

Isometric PCM should be considered in patients with prodromes who are <60 years of age.

Tilt training may be considered for the education of young patients.

There is moderate evidence that PCM is effective in reducing syncopal recurrences in patients <60 years old with long-lasting recognizable prodromal symptoms.

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