Managing Fatigue in the Syncope Unit

Julia L. Newton


Europace. 2012;14(12):1696-1699. 

In This Article

Abstract and Introduction


The symptom of fatigue is frequently described by patients attending the syncope unit with a wide range of conditions including vasovagal syncope and postural orthostatic tachycardia syndrome. It is possible that the presence of autonomic dysfunction provides the common pathogenetic mechanism linking neurally mediated hypotension and fatigue. Managing this debilitating symptom can often be challenging but, with a structured approach, immensely rewarding, and as a result improve how patients cope with their disease.


Fatigue is a common, debilitating symptom that affects a large proportion of the population.[1] Studies suggest that 10% of general practice consultations are for the symptom of fatigue and that 10% of the population has experienced fatigue that impacts upon their ability to function for longer than a month.[2] Despite it being a common symptom, and the impact that it has upon an individual's ability to function on a daily basis, it is poorly understood, and often overlooked in conventional clinical management. The importance of fatigue in those with chronic diseases and community populations is underlined by its association with excess mortality[3] and functional impairment.[4]

In the syncope unit we are increasingly managing the symptom of fatigue in the patients that we see, either because patients have come to the Unit referred with concomitant syncope, or presyncope, or because of the increasingly recognized overlap between syndromes such as neurally mediated hypotension and positional orthostatic tachycardia in patients with fatigue-associated chronic diseases[5,6] and in those with chronic fatigue syndrome (CFS).[7,8]