Q. All of the following are effective in the management of reflex syncope except
A. Life style modifications like avoiding triggers
B. Physical counterpressure maneuvers
C. Beta blockers
D. Cardiac pacing in patients with cardioinhibitory reflex syncope
According to ESC guideline 2009, beta blockers are no longer recommended and have been given class III recommendation for the treatment of reflex syncope. The first step in the management of reflex syncope is life style modifications like – avoiding triggers such as crowded places, prolonged standing etc.
-Physical counterpressure maneuvers are emerging as nonpharmacologic treatments for
syncope. These maneuvers include tensing of crossed legs, handgrip and arm tensing, abdominal binders, and support stockings.
-Class IIa recommendations include cardiac pacing for patients with dominant cardioinhibitory, carotid sinus sensitivity, and frequently recurrent reflex syncope after 40 years of age with documented cardioinhibitory responses during monitoring.
-Remember that pacemaker implantation in patients with reflex syncope and no evidence of cardioinhibitory reflexes is not indicated and can be harmful (class III).
1. Guidelines for the diagnosis and management of syncope (version 2009) The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC). European Heart Journal (2009) 30, 2631–2671
Keywords: Cardiology review, Cardiology, Multiple choice questions, medical tudents, Electrophysiology, Syncope