Quick and complete recovery after a short-term sudden loss of consciousness is called fainting. Symptoms such as dizziness or lightheadedness are called presyncope; however, these symptoms may also occur in situations that are 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 lose consciousness if they do not receive medical help. However, people with syncope usually recover in a short time without treatment. However, serious injuries that occur during fainting can be frightening. On the basis of heart disease. Fainting that develops causes serious rhythm disturbances in the future; detailed cardiac evaluation is required to detect possible negative events in the future. Low blood sugar, hyperventilation and epileptic seizures also cause the person to faint, but they are not syncope.
Frequency:Syncope is common in the population, but an individual rarely has more than one attack during his or her lifetime. Approximately one-third of people have experienced a syncope attack at some point in their life. In most cases, fainting is not a life-threatening condition, but some patients have underlying medical problems. There is no underlying cause in 75% of young patients with syncope. 35% of people with syncope, especially the elderly, injure themselves.
Causes of fainting:
Conscious. In order to survive, continuous oxygen support must be provided to the brain. Syncope occurs when oxygen support is stopped, even for a short time.
-Vasovagal syncope:It is the most common type of fainting, also called neurocardiogenic syncope. Fluid loss, It triggers conditions such as bleeding, physical and psychological stress, and pain. Hypotension, which occurs as a result of a sudden decrease in heart rate and/or dilation of the vessels in the body and pooling of blood in the legs, causes syncope. In some patients, exposure to extreme heat, seeing blood, fear of injury, and extreme pain may trigger the development of vasovagal syncope. In some other patients, swallowing, urination, bowel movement and coughing may be triggers. Some patients may experience symptoms such as feeling hot or cold, excessive sweating, tunnel-like vision and nausea before fainting.
-Heart ri Tim problems:A series of disorders in the speed and/or rhythm of the heart may cause fainting. The stimulation in the heart: is initiated from the sinus node containing specialized cells located on the right atrium. After the electrical stimulation passes the atria, the specialized conduction system stimulates the heart muscle and regular contraction begins.
Problems 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 output of stimulation from the sinus node), heart blocks (pause in the conduction system). delay), supraventricular and ventricular tachycardia may cause syncope.
- Conditions that prevent blood flow within the heart:Hypertrophic cardiomyopathy, aortic stenosis, mitral stenosis, intracardiac tumor, intracardiac clot. Syncope can be caused by diseases that obstruct blood flow within the heart, such as heart formation. Fainting may occur in people with these diseases, especially during exertion, which is an indication that this condition is serious.
-Orthostatic hypotension:From a sitting position to standing up. When you stand up, blood pools in the legs due to the effect of gravity and blood pressure decreases in the arteries. If this is severe, fainting occurs as a result of low blood flow to the brain.
Orthostatic hypotension can be caused by some diseases and medications; blood or fluid loss, some Antidepressants, blood pressure medications, and opiate medications are some of them. Parkinson's disease, diabetes, amyloidosis, shy-drager syndrome, carotid sinus hypersensitivity, and excessive alcohol consumption also cause orthostatic hypotension.
Diagnosis of Syncope:
strong>There are three main ways to diagnose syncope: medical history, physical examination, cardiac tests. Medical history and physical examination are required for all patients, some patients may require cardiac tests.
Medical History: Collecting information about the symptoms before, during and after syncope gives an idea about the diagnosis. Nausea and sweating before syncope suggest that there may be vasovagal syncope. On the other hand, sudden loss of consciousness without any signs strongly suggests a heart rhythm problem. People who develop syncope during exercise primarily aortic stenosis and hypertrophic It is necessary to consider cardiomyopathy. It is necessary to collect information about the person's previous health condition and the medications used. If there is loss of consciousness with abnormal body movements and convulsions, 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 disturbance can be detected during 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 the examination of heart sounds. If a low pulse occurs by carotid artery massage, carotid sinus syncope is diagnosed.
Tests:
-Electrocardiography (ECG): It should be performed on all patients who faint. ECG shows the picture of electrical activity in the heart. It does not cause any harm to the patient. Normal ECG does not mean that fainting is not due to a heart rhythm problem. .Since heart rhythm problems are short-term, the ECG may be normal at that moment.
-Rhythm monitor: If no problem is detected in the utin ECG, it allows rhythm monitoring at home or in the hospital. Holter monitor that allows 24-48 hours of monitoring and more. Loop recorders that allow long-term 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 necessary to diagnose vasovagal syncope. It is a test
-Electrophysiological study: It should be done in patients with syncope thought to be due to heart rhythm problem.
-Exertion Test: It is especially necessary for patients who describe syncope during exertion.
Treatment:
In people diagnosed with vasovagal syncope, fluid and salt intake should first be increased. Isometric reverse pressure maneuvers applied to the legs or arms may cause an increase in blood pressure at the moment syncope develops. Many drugs are used in the treatment of vasovagal syncope. However, there is no effective treatment. A permanent pacemaker may be considered in patients with vasovagal syncope who are symptomatic and at risk of injury.
In patients with vasovagal syncope and orthostatic hypotension, massage of the legs before standing up and orthostatic training exercises such as elastic socks may be beneficial.
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