100 QUESTIONS IN CARDIOLOGY

Head up tilt diagnosis of vasovagal

syncope

(Hypotension/bradycardia with

symptom reproduction)

Patient education/conservative advice/

Withdrawal of culprit medication

Significant cardio-

inhibitory response (with

frequent/severe/injurious

unheralded syncope)

No significant cardio-

inhibitory response

24 hour urinary sodium

< 170mmol/L > 170mmol/L

Salt loading

Still symptomatic 
Blocker/SSRI

Still symptomatic/

cannot tolerate/

contraindicated

Fludrocortisone

and/or Midodrine

Still symptomatic

Consider Dual Chamber

Permanent Pacemaker

(with rate drop response

algorithm)

Consider: tilt training, fluid

therapy, anticholinergic,

enalapril, oral theophylline

Still symptomatic

Still symptomatic

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