Syncope Triggered by Anxiety, Fear, or Pain: Cases and Associated Factors

Abstract

Background : Receiving a blow, severe pain, having blood drawn, or experiencing intense emotion is known to be able to trigger a vasovagal syncope. In some patients, syncope is even caused by fear of academic situations. Our objective is to describe our cases and what factors are associated with this condition. Methods : We present 188 patients with vagal syncope associated with pain or emotion (P/E patients) and compare them with individuals (non P/E patients) in whom vagal syncope is triggered only a period of standing (n: 323/63%). All underwent clinical examination and a tilt test (HUT). Results : The age of onset and sex are clearly different between the two groups (P/E group: 20 years old, 29 years old in non P/E patients). 74% of the patients are women. In them, the age of onset is 19 years versus 27 years in men. 44% of patients reported having affected first-degree relatives, and 20% in second-degree relatives. 83% of this inheritance comes from the maternal line. 48% of cases present a significant degree of joint hypermobility. 74% of cases show an important degree of venous pooling in the lower extremities during prolonged standing in the tilt test. The influence of all these factors, is analyzed in our study. Conclusions : Factors associated with P/E syncope include female sex, very young age of onset, joint hypermobility, venous pooling during standing, and a hereditary tendency to experience syncope, especially from the maternal line.