Patient handout

Neurally-Mediated Reflex Syncope (vasovagal / situational / carotid sinus)

PRODUCTION

1. Your condition

This handout is for neurally-mediated reflex syncope (vasovagal / situational / carotid sinus). Your care team identified this based on: transient loss of consciousness with rapid spontaneous recovery (esc 2018 brignole — definition of syncope).

Other reasons your team may use this plan: prodrome of warmth, nausea, diaphoresis, blurred vision, lightheadedness (esc 2018 — classic vasovagal prodrome); trigger — emotional stress, prolonged standing, micturition, defecation, cough, swallowing (acc/aha/hrs 2017 — situational subtypes); recurrent reflex syncope despite lifestyle measures (esc 2018 — pharmacotherapy/pacing indication).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
oral_rehydration_salt_loading	2–3 L water + 6–10 g sodium daily (if not contraindicated)	PO	daily	ESC 2018 Class I / ACC/AHA/HRS 2017 Class I — first-line for all reflex syncope; expands intravascular volume

Plan: Reflex syncope stepwise therapy (lifestyle → pharmacotherapy → device for cardioinhibitory subtype) (ACC/AHA 2022)

3. When to call your provider

Contact your care team if any of the following happen:

New high-risk symptoms (palpitations, exertional, supine, injury) → cardiology + cardiac workup (ACC/AHA 2022)
Persistent disabling recurrence despite Step 3 → autonomic specialist + ILR + tilt re-evaluation

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

New long QT, Brugada pattern, WPW, AV block, BBB with axis change, ischemic changes, or ARVC pattern (ESC 2018 Table 5 high-risk ECG features)
Syncope occurred during exertion or while supine (ESC 2018 — red flag for cardiac syncope)
First-degree relative <40 with sudden cardiac death or known channelopathy / cardiomyopathy (ACC/AHA/HRS 2017 high-risk feature)
Recurrent syncope ≥2/yr, age >40, asystole ≥3 s on tilt or ILR (cardioinhibitory) (ACC/AHA 2022)
Syncope with injury or absent prodrome — raises cardiac etiology (ESC 2018 Brignole — high-risk feature)

5. Follow-up

Driving restrictions per local rules (ESC 2018 §6.4); occupational counselling; reassessment of BP-lowering meds; safety planning for warning signs + counterpressure maneuvers (ACC/AHA/HRS 2017)

6. Sources

Guideline: 2017 ACC/AHA/HRS Syncope Guideline + 2018 ESC Syncope Guideline (BIOSync 2020 update)