Malignant vasovagal syncope (malignant vasovagal syndrome) may be interpreted in two ways. The first (and usual) interpretation is vasovagal episodes that are frequent and that result in a serious threat to the patient. The second is vasovagal syncope associated with an underlying malignancy.


Clinical features:

(1) recurrent episodes with loss of consciousness

(2) hypotension during the episode

(3) variable apnea during the episode

(4) variable warning symptoms prior to the episode (sweating, pallor, nausea, headache, lightheadedness, etc)

(5) symptoms after the episode (headache, lethargy, weakness) that clear within an hour


Features make "malignant" in the absence of underlying cancer:

(1) frequent

(2) associated with serious injury

(3) result in significant clinical impairment


Nonmalignant causes:

(1) Wolff-Parkinson-White syndrome

(2) episodes of cardiac asystole


Tumors can result in vasovagal syncope with:

(1) compression of the vagus nerve along its course

(2) compression of the carotid body

(3) expansion within the middle ear


To read more or access our algorithms and calculators, please log in or register.