Fludrocortisone is a synthetic selective mineralocorticoid when used in small doses; it retains salt and water and promotes plasma volume expansion.
Norcliffe LJ, Bush V Hainsworth R 2002 Patients with posturally-related syncope have increased responsiveness of the cerebral circulation in carbon dioxide. Orthostatic hypotension , a common benign cause of syncope, results from failure of normal mechanisms eg, sinus tachycardia, vasoconstriction, or both to compensate for the temporary decrease in venous return that occurs with standing.
Warning symptoms eg, dizziness, nausea, sweating ; recovery usually prompt but not immediate 5 to 15 min or longer, but sometimes up to hours Precipitant usually apparent. Atypical forms of reflex syncope include those situations in which reflex syncope occurs with uncertain or absent triggers.
Alarming features indicating a high-risk scenario include syncope during exertion, syncope while lying down, family history of sudden cardiac death, or slow recovery from syncope. Serious arrhythmogenic events, coronary insufficiency syndromes, pulmonary embolism, strokes or transient ischemic attacks, and blood loss require immediate medical care.
These signals cause vasodilation, hypotension and bradycardia.Treatments for Syncope
The ECG may reveal arrhythmia, a conduction abnormality, ventricular hypertrophy, pre-excitation, QT prolongation, pacemaker malfunction, myocardial ischemia, or MI. In witnessed syncope, pulses are checked immediately. Testing typically is done. Syncope due to cardiac arrhythmias typically occurs abruptly and with quick recovery. In patients with prominent hyperadrenergic features, it is reasonable to use clonidine or alpha-methyldopa.
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Young patients with psychiatric disease have high rates of recurrence of pseudosyncope. Tilt testing is indicated in cases of unexplained single syncopal episode in a high-risk patient; in recurrent syncopal episodes in the absence of organic heart disease; or in the presence of organic heart disease after a cardiac cause of syncope has been ruled out.
Mechanisms of orthostatic hypotension and tachycardia in patients with pheochromocytoma.