J Clin Neurol.  2006 Mar;2(1):66-69. 10.3988/jcn.2006.2.1.66.

Successful Treatment of Vasovagal Syncope Due to Blood-Injury Phobia by Physical Maneuvering

• Han BI
• Oh HJ
• Bang OY
• Lee JH

• KMID: 2287705
• DOI: http://doi.org/10.3988/jcn.2006.2.1.66

Abstract

Blood-injury phobia may present as a vasovagal syncope in response to the sight of blood or after receiving venipuncture. A 26-year-old man presented with a history of syncope induced by venipuncture. A transcranial Doppler (TCD) scan with monitoring of both heart rate and blood pressure reproduced the syncope and showed it to be vasovagal in nature. Treatment by practicing physical maneuvers, such as leg crossing and muscle tensing, improved the condition of the patient. This case suggests that physical maneuvering is effective in the treatment of blood-injury phobia.

Keyword

Blood-injury phobia; Syncope; Transcranial Doppler; Physical maneuver

MeSH Terms

Adult
Blood Pressure
Heart Rate
Humans
Leg
Phlebotomy
Phobic Disorders*
Syncope
Syncope, Vasovagal*
Transcutaneous Electric Nerve Stimulation

Figure

• 

  Figure 1 Changes in Transcranial Doppler (TCD) parameters before venipuncture (A), during presyncope (B), and during syncope (C), in the left middle cerebral artery of a patient with blood-injury phobia. The mean blood flow velocity, peak systolic velocity, diastolic velocity, and pulse rate all decreased, while the pulsatility index increased.

• 

  Figure 2 Physical maneuvers for syncope. Leg crossing and muscle tensing are performed simultaneously by tensing the muscles of the arms, chest, abdomen, buttocks, and legs while the legs are crossed (A). Sitting (B). Head lowering (C). Squatting is recommended if the previous physical maneuvers fail to stop dizziness (D). Note that the height of the head decreases when going from the standing position to the squatting position.

• 

  Figure 3 Effects of leg crossing and muscle tensing on systolic blood pressure after venipuncture while standing during different sessions. Leg crossing and muscle tensing ameliorated the drop in systolic blood pressure sufficiently to abort syncope while standing during the third therapeutic session.

Reference

1. Hagopian LP, Crockett JL, Keeney KM. Multicomponent treatment for blood-injury-injection phobia in a young man with mental retardation. Res Dev Disabil. 2001. 22:141–149.

2. Accurso V, Winnicki M, Shamsuzzaman AS, Wenzel A, Johnson AK, Somers VK. Predisposition to vasovagal syncope in subjects with blood/injury phobia. Circulation. 2001. 104:903–907.

3. Diehl RR, Linden D, Chalkiadaki A, Diehl A. Cerebrovascular mechanisms in neurocardiogenic syncope with and without postural tachycardia syndrome. J Auton Nerv Syst. 1999. 76:159–166.

4. Krediet CT, van Dijk N, Linzer M, van Lieshout JJ, Wieling W. Management of vasovagal syncope: controlling or aborting faints by leg crossing and muscle tensing. Circulation. 2002. 106:1684–1689.

5. Vogele C, Coles J, Wardle J, Steptoe A. Psychophysiologic effects of applied tension on the emotional fainting response to blood and injury. Behav Res Ther. 2003. 41:139–155.

6. Kaufmann H. Syncope. A neurologist's viewpoint. Cardiol Clin. 1997. 15:177–194.

7. Weimer LH. Evans RW, editor. Autonomic function. Diagnostic testing in neurology. 1999. Philadelphia: W.B. Saunders;337–365.

8. Brignole M, Alboni P, Benditt D, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al. Task force on syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope. Eur Heart J. 2001. 22:1256–1306.

9. Hellstrom K, Fellenius J, Ost LG. One versus five sessions of applied tension in the treatment of blood phobia. Behav Res Ther. 1996. 34:101–112.

10. Smit AA, Hardjowijono MA, Wieling W. Are portable folding chairs useful to combat orthostatic hypotension? Ann Neurol. 1997. 42:975–978.

11. van Dijk N, de Bruin IG, Gisolf J, de Bruin-Bon HA, Linzer M, van Lieshout JJ, et al. Hemodynamic effects of leg crossing and skeletal muscle tensing during free standing in patients with vasovagal syncope. J Appl Physiol. 2005. 98:584–590.