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I am 22 years old. A year ago I had severe chest pain, vomiting, headache and then I passed out. Now it happened again, with two blackouts in one week. The pressure suddenly dropped to 65/55 and then rose again after half an hour. Do I have to worry?

He answers Massimo MapelliCritical and Rehabilitative Cardiology Department, Monzino Cardiology Center, Milan (VAI AL FORUM)

In the Mickey Mouse comics I read as a youngster, Scrooge McDuck often passed out by falling crashing to the ground. In most cases the phenomenon occurred while the protagonist was standing, in a hot and crowded place and just after an intense emotional reaction. Then she slowly regained consciousness, asking: Bring me my salts. I have just described what is usually defined a vague reactionin terms of clinical presentation. The vagus is a nerve – or rather a set of nerve impulses – that runs through our body and affects half of our autonomic nervous system. It is a question of all that series of inputs capable of regulating, as in a control unit independent of our direct will, a vast series of physiological functions, including intestinal motility, the urge to urinate or the width of our pupils. Not only. The activation of the vagal system – which is opposed to the sympathetic one – is associated with a reduction in blood pressure and heart rate values, especially in predisposed subjects (young and often anemic women).

When this response becomes very pronounced, the pressure and frequency values ​​drop so much that we lose our senses. It is an occurrence that scares a lot but which, net of the risk of trauma in the fall, is benign and on the contrary, it represents an ancestral defense mechanism of our body which allows, in a lying position, to favor the venous return to the heart of the fluids that tend to accumulate in the lower limbs, improving cerebral perfusion. This is only one of the causes that can induce fainting, but by far the most probable. With a thorough history and some tests, the cardiologist should be able to avoid more serious (very rare) causes of syncope. If the vagus nerve is the source of the problems, drug therapy is limited. We focus on behavioral treatmentdesigned to reduce exposure to predisposing situations: it is necessary to drink plenty of water to avoid dehydration, sit down (or lie down) at the first appearance of symptoms and, in selected cases, provide for the use of elastic stockings to help venous return.