Syncope (Fainting)

A rapid and complete recovery after a short period of sudden loss of consciousness is called fainting. Symptoms such as lightheadedness or lightheadedness are called presyncope (the pre-fainting state), although these symptoms can also occur in cases not related to fainting.

Sudden cardiac arrest should not be confused with fainting; people with sudden cardiac arrest also develop sudden loss of consciousness and die if they do not seek medical help. However, people with syncope often recover without treatment in a short time. However, serious injuries that occur during fainting can be frightening. Fainting will cause serious rhythm disturbances in the future; it definitely requires a detailed cardiac evaluation in order to detect adverse events that may occur in the future. Low blood sugar, hyperventilation and epileptic seizures also cause the person to pass out, but they are not syncope.

Frequency:Syncope is common in the community, but an individual rarely has more than one episode in their lifetime. Approximately one-third of people have experienced syncope at some point in their life. In most cases, fainting is not life-threatening, but some patients have underlying medical problems. 75% of young syncope patients There is no underlying cause. 35% of people with syncope, especially the elderly, injure themselves.

Reasons for fainting:

In order to remain conscious, continuous oxygen support must be provided to the brain. Syncope occurs when the oxygen support is interrupted, even for a short time.

-Vasovagal syncope:It is the most common type of fainting, also called neurocardiogenic syncope. It triggers conditions such as fluid loss, bleeding, physical and psychological stress, and pain. Hypotension, which occurs as a result of sudden decrease in heart rate and/or enlargement of the blood vessels in the body, creates syncope. In some patients, swallowing, urination, bowel movement and coughing may be triggers. symptoms may occur.

-Heart rhythm problems:A series of disorders in the rate and/or rhythm of the heart may cause fainting. The heartbeat: It is initiated from the sinus node, which contains specialized cells on the right atrium. After the electrical stimulation atria passes, the specialized conduction system stimulates the muscle of the heart and regular contraction begins.

Problems occurring at various points in the heart’s conduction system may cause fainting. These problems may be primary heart rhythm problems, cardiovascular diseases and drug interactions. Sinus bradycardia (decrease in the impulse output from the sinus node), heart blocks (pause-delay in the conduction system), supraventricular and ventricular tachycardia may cause syncope.

Conditions that prevent blood flow in the heart:Diseases that prevent blood flow in the heart, such as hypertrophic cardiomyopathy, aortic stenosis, mitral stenosis, intracardiac tumor, intracardiac clot formation, may cause syncope. Fainting can be seen in people with these diseases, especially during exertion, which is an indication that this situation is serious.

-Orthostatic hypotension:When you stand up from a sitting position, blood pressure drops as a result of the pooling of blood in the legs with the effect of gravity and the decrease in blood in the arteries. If this is severe, fainting occurs as a result of insufficient blood flow to the brain.

Some diseases and drugs may cause orthostatic hypotension; blood or fluid loss, some antidepressants, blood pressure drugs, opiate drugs are some of them. Parkinson’s, diabetes, amyloidosis, Shy-Drager syndrome, carotid sinus hypersensitivity and excessive alcohol consumption can also cause orthostatic hypotension.

Syncope Diagnosis:

There are three main ways to diagnose syncope: medical history, physical examination, cardiac tests. Medical history and physical examination are essential for all patients, cardiac testing may be required in some patients.

Medical history: Gathering information about the symptoms occurring before, during and after syncope gives an idea about the diagnosis. Nausea and sweating before syncope suggests vasovagal syncope. On the other hand, sudden loss of consciousness without any sign suggests a heart rhythm problem. In people, first of all, aortic stenosis and hypertrophic cardiomyopathy should be considered. It is necessary to collect information about the person’s previous health status and the drugs he used. If there is loss of consciousness with abnormal body movements and contractions, it is necessary to consider an epileptic seizure.

Physical Examination: Routine cardiac examinations of all patients should be performed by the clinician. Syncope due to heart rhythm disorder can be detected on examination. To diagnose syncope due to orthostatic hypotension, blood pressure should be measured while sitting and lying down. Aortic stenosis and hypertrophic cardiomyopathy can be detected during examination of heart sounds. Carotid artery massage If a low heart rate occurs, the diagnosis of carotid sinus syncope is made.

Tests:

-Electrocardiography (ECG): It should be done in all patients with fainting. The ECG shows the picture of the electrical activity in the heart. It does not harm the patient.

– Rhythm monitor: If no problem is detected in the utin EKG, it allows rhythm monitoring at home or in the hospital. Holter monitors that allow 24-48 hours monitoring and loop recorders that allow longer monitoring can be used.

-Echocardiography: It is a kind of ultrasonography of the heart; it allows us to detect structural abnormalities.

-Tilt table test: It is the test required to diagnose vasovagal syncope.

-Electrophysiological study: It should be done in patients with syncope thought to be due to a heart rhythm problem.

-Exercise Test: It is especially necessary for patients who describe syncope during exertion.

Treatment:

First of all, fluid and salt intake should be increased in people diagnosed with vasovagal syncope. Isometric reverse pressure maneuvers applied to the legs or arms may cause blood pressure to increase as soon as syncope develops. Many drugs are used in the treatment of vasovagal syncope, but there is no effective treatment. pacemaker may be considered.

In patients with vasovagal syncope and orthostatic hypotension, orthostatic training exercises such as massaging the legs before standing up and elastic stockings may be beneficial.

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