MANAGEMENT OF VASOVAGAL SYNCOPE

Since the advent of the tilt test, our understanding of the pathogenes is of vasovagal syncope has progressed greatly, Two mechanisms lead to the sudden fall in blood pressure: on one hand a series of interrelat ed neuroreflexes, and on the other, neuroendocrine effects, Althougth our understanding is not complete, new therapeutic mesures can be prop osed beyond simple empiric prescriptions of vagolytic agents, The effi cacy of different treatments is yet to be proven due to the need for l ong controlled trials with large numbers of subjects, In the early stu dies versus placebo, no significant evidence of a preventive effect ag ainst recurrent malaise could be distinguished from the placebo effect , Complementary investigations such as the tilt test also act asa plac ebo, While firm recommendations for effective prevention cannot be est ablished until the results of controlled trials are available, it is n evertheless possible to propose a reasonable approach to management.