Vasovagal Syncope as a Cause of Unexplained Dyspnea and Chest Pain

Abstract

Background: Unexplained dyspnea and chest pain remain a diagnostic challenge in clinical practice. After exclusion of ischemic heart disease through non-invasive stress imaging and coronary angiography, a substantial proportion of patients continue to experience persistent symptoms without identifiable organic cause. Vasovagal syncope, mediated through abnormal autonomic reflexes, has emerged as an underrecognised aetiology in this population. The tilt table test offers a non-invasive, reproducible method for unmasking autonomic instability and vasovagal susceptibility in such patients. This review examines the pathophysiology of vasovagal responses, the differential diagnosis of unexplained chest pain and dyspnea, and the diagnostic utility of tilt table testing, with particular attention to predictors of test positivity.