Patients should contact their physician if there is a change in frequency or presentation of symptoms.
Patient education is an important factor in treatment for all types of NMRS.[1]Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines, and the Heart Rhythm Society. Heart Rhythm. 2017 Aug;14(8):e155-217.
https://www.heartrhythmjournal.com/article/S1547-5271(17)30297-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/28286247?tool=bestpractice.com
Patients should avoid or mitigate situations where syncope has occurred in the past (e.g., prolonged standing, pain, emotional distress, defecation, dehydration).[1]Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines, and the Heart Rhythm Society. Heart Rhythm. 2017 Aug;14(8):e155-217.
https://www.heartrhythmjournal.com/article/S1547-5271(17)30297-7/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/28286247?tool=bestpractice.com
If they experience prodromal symptoms (e.g., dizziness, changes in vision/hearing), advise patients to lie down if possible (and if it is safe to do so) with their legs elevated. Patients may try arm counter-pulsation (pulling contralateral hands against each other, hooking the hands together, and pulling with the arms), leg tensing, and leg crossing to try to improve venous return to the heart, and therefore perfusion of the brain.[56]Krediet CT, van Dijk N, Linzer M, et al. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002 Sep 24;106(13):1684-9.
https://www.ahajournals.org/doi/10.1161/01.CIR.0000030939.12646.8F
http://www.ncbi.nlm.nih.gov/pubmed/12270863?tool=bestpractice.com
[57]Brignole M, Croci F, Menozzi C, et al. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. J Am Coll Cardiol. 2002 Dec 4;40(11):2053-9.
https://www.jacc.org/doi/10.1016/S0735-1097%2802%2902683-9
http://www.ncbi.nlm.nih.gov/pubmed/12475469?tool=bestpractice.com
For prevention, patients can try support stockings that extend to the thigh.