Recommended non-drug measures – advice for patients.
- Avoid situations likely to induce syncope – for example, standing in a queue, taking a long hot bath, eating a large carbohydrate-rich meal in a warm restaurant, or failing to drink sufficient fluid in a hot nightclub.
- Take immediate action at the first warning of an impending collapse. If a collapse is imminent lie down flat propping your legs up on a chair or against a wall or sit down with your head between your knees. Squatting down on ones heels can be very effective and is less likely to attract attention in public . All these manoeuvres help reverse venous pooling of blood in the limbs, swiftly restoring blood flow to the brain and alleviating symptoms. When sufficiently recovered get up carefully. If your symptoms return or worsen squat down, or lie down again.
- Stand with your legs crossed, rhythmically squeezing one into the other, or rock backwards and forwards on your heels, if a collapse is not imminent. These manoeuvres activate the muscle pump in your legs and move blood from the limbs into the chest. Pulling vigorously on clasped hands, or squeezing firmly on a ball, may also be effective.
- Drink 200 mls of water. This promptly increases blood pressure in normal subjects and in patients with autonomic failure. It may also be helpful in preventing vasovagal syncope. Ensuring adequate intake, as determined by the clear appearance of urine, may help prevent collapses.
- Increase your dietary intake of salt if your oral intake is low – 24 hour urinary sodium excretion is a proxy measure. This may be achieved by adding salt at the table, taking salt tablets (Slow Sodium) or drinking “sport” drinks. Up to 10 g of sodium per day may be required – equal to about 16 Slow Sodium tablets, each of which contain 600 mg. The benefits from increasing salt intake are noticed within two or three days. You should not increase your salt intake if you have hypertension – high blood pressure.
- Sleep with the head of your bed raised by about 10°. This reduces urinary salt loss overnight.
- Endurance training can be helpful if you are not fit. Using a rowing machine is an excellent form of exercise and may reduce your tendency to collapse.
- Tilt table training has been used successfully, but needs to be maintained as de-conditioning occurs rapidly on cessation.