P&S Monitoring tests for Vagal or Parasympathetic Excess (PE) without the need for tilt-table and is often more revealing. Strapping the patient on the table stimulates the Sympathetic nervous system and the patients do not become symptomatic. While tilt-table testing is often considered the test of choice for differentiating Vasovagal Syncope, the simple placement of the patient on the tilt-table already treats the patient. Testing and Treatment of Vasovagal Syncope Excess in Vagus activity intermittently can cause loss of consciousness. When it becomes overactive it can prevent the heart rate from pumping blood to the brain, which can occur with Vasovagal Syncope. The Vagus nerve is also important in lowering heart rate and blood pressure. Many people who suffer from gastrointestinal symptoms have an abnormality of the communication between the brain and the gut with so called brain-gut connection, as the Vagus nerve delivers information from the gut to the brain, and then back again through the motor branches connected to the gut muscles to move the stomach and intestines – this is the source of “butterflies” in your stomach when you are nervous about something. The Vagus nerve activity is extremely important in our bodily functions, such as urination, defecation and sexual function. As mentioned above, the Parasympathetic function is important for the urinary tract, digestive tract, respirations and heart rate functioning. In terms of motor, it provides an important function for the muscles in the neck responsible for swallowing and speech. It has special sensory functions in providing sensation behind the tongue at the back of the mouth and top of the throat – the gag reflex. For example, the sensory input from the throat, heart, lungs and abdomen is part of the Vagus nerve. The Vagus nervous system has Parasympathetic motor special sensory and sensory functions. It basically links many organ systems to the brain. The Vagus nerve is also monitored for sensory activities and motor information for movement within the body. This is a part of the nervous system that slows digestion, slows heart rate and causes the urinary bladder to contract or the GI tract to have motility. The Vagus nerve is an intricate part of the autonomic nervous system, a part of what we term the Parasympathetic nervous system. What it actually does is allow the brain to monitor and receive information about many of the various organs’ different functions in the body. It has two branches of sensory nerve cells in the body and it connects the brain stem to the body. There are 12 cranial nerves that emanate from the central nervous system. The Vagus nerve is the 10th cranial nerve in the body. One needs to first know what the Vagus nerve actually is. Oftentimes, Vasovagal Syncope is known as neurocardiogenic syncope or reflex syncope. At times, both mechanisms can be operative, simultaneously. It can also cause a slow heart rate sometimes down to 20 beats per minute, which can also lead to reduced cardiac output. This reflex causes a sudden dilatation of the blood vessels of the legs where pooling of blood occurs in the lower extremities. What happens is one has a temporary loss of consciousness when a neurological reflex is activated. Vasovagal Syncope is also known as a “simple fainting spell.” It is mediated by a neurological reflex within the body. She wanted to know what the mechanism of this so called Vasovagal Syncope was and how was it prevented. She had this for several instances and at times had to lie down to prevent an episode of fainting. She was given IV fluids and told she had a Vagal or Vasovagal episode and released. She was brought to the emergency room where she was examined and found to be perfectly normal. The next thing she knew was she was on the ground. Her vision began to become tunneled and her hearing faded. She became nauseous and had abdominal discomfort. She was in a warm room that was crowded and was standing for a long period of time. One patient was in the emergency room after having an episode of passing out. We are often asked by a patient to explain to them what Vasovagal Syncope is. The following is a rephrased excerpt from the book Clinical Autonomic and Mitochondrial Disorders by Doctors DePace and Colombo, Springer Publishers, Switzerland, 2019.
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