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Vasovagal Syncope — EECC MCQ

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EasyGeneral CardiologyVasovagal SyncopeEECC

A 45-year-old woman presents with recurrent syncope. She has no structural heart disease, normal ECG, and a normal echocardiogram. Her syncope episodes occur while standing in queues and are preceded by prodromal symptoms (warmth, nausea, visual greying). She recovers quickly. What is the most likely diagnosis and appropriate investigation?

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Correct answer: A — Vasovagal syncope — tilt table testing may be considered to confirm the diagnosis if the history is unclear, but a classical history is often sufficient

This is a classic presentation of vasovagal (neurocardiogenic) syncope: triggered by prolonged standing, preceded by prodromal symptoms (autonomic activation — warmth, nausea, diaphoresis, visual disturbance), brief loss of consciousness with rapid recovery, and no structural heart disease. The ESC Syncope Guidelines (2018) state that a classical history of reflex syncope with identifiable triggers is often sufficient for diagnosis without additional testing (Class I). Tilt table testing may be considered (Class IIb) when the diagnosis is uncertain. Management includes education, trigger avoidance, physical counter-pressure manoeuvres (leg crossing, muscle tensing), adequate hydration and salt intake, and avoidance of prolonged standing.

Reference: ESC (2018): Guidelines on Syncope