Although the term SYNCOP is translated into Turkish as "FAIGNING", its meaning in the literature is actually slightly different. Roughly, we can say that it is a type of "fainting" or "temporary loss of consciousness".
When we say "fainting", we can understand all kinds of temporary loss of consciousness.
However, SYNCOP; It is defined as “sudden-rapid onset, short-term, spontaneously recovering, temporary loss of consciousness due to temporary decrease in cerebral blood flow”.
According to this definition, while epileptic seizures, psychological fainting (conversion, hysteria), loss of consciousness due to hypoglycemia (low blood sugar) can be called "fainting", they cannot be called "syncope" because their mechanism is not "decreased cerebral blood flow". .
In this case, other conditions that may be confused with the causes of syncope should be distinguished by the physician. Other situations that may be confused with syncope:
- Partial or Complete Loss of Consciousness Without Reduction in Cerebral Blood Flow
Epilepsy
Metabolic disorders
Hypoglycemia (Low blood sugar)
Hyperventilation (Changes in blood as a result of rapid and deep breathing)
Hypoxia (Decrease in the amount of oxygen in the blood)
Poisonings
Transient ischemic attack caused by vertebrobasilar
- Situations Occurring Without Disorder of Consciousness
Psychological fainting (Pseudosyncope = False syncope)
Falls, falling attacks
Catalepsy (mostly in schizophrenia, temporary loss of muscle strength)
Transient ischemic attack originating from the carotid (cervical vein)
Exactly as we mentioned when describing "palpitations", the past has happened in a syncope attack that we do not know when it will happen again, most of them There is no evidence at the time. So to speak, there is a situation with an unknown perpetrator, and we are detectives trying to reach the perpetrator by conducting our interrogation, based on clues. The story of syncope is as valuable to us as the place, time, before and after the incident, and the moment of the incident are to a detective.
Patient in syncope, Since he cannot know his condition after the moment he loses consciousness, the observations and stories of those who are with him at that moment are at least as valuable as the patient's stories. For this reason, it is important for those who come to us with a complaint of syncope to bring witnesses with them, if any, or to tell us exactly what the witnesses told us, on the way to diagnosis.
Let's write down the questions we asked to evaluate the cause of syncope here, so that those who will come to us with this complaint. Those who are interested should come prepared. :)
1.) Questioning Before the Attack
Position? ;
Standing, sitting, or lying on your back…
Activity ? ;
What exactly were you doing when syncope occurred? at rest, during body position change, before or after exercise, urination, defecation, cough…
Predisposing or Triggering Factors ?
Crowded and hot places , closed and narrow environment, stress, standing for a long time, after meals, fear, stress, head movements…
Situations seen at the beginning of the attack?
Nausea , vomiting, abdominal pain, rumbling, feeling cold, sweating, pain in the neck and shoulders, blurred vision, dizziness, palpitations…
2.) Questioning the Syncope Attack
Fall pattern
Skin color (pale, cyanous, redness),
Duration of loss of consciousness,
Breathing pattern,
Movements and duration of movements
Biting the tongue,
Urinary incontinence,
Foam from the mouth, shape of the eyes
Blood pressure and pulse, if measured,
Attack frequency,
Table: SYNCOPE CLASSIFICATION
3.) Questioning the Patient's History
A family history of sudden death, congenital arrhythmogenic heart disease or fainting
Previous heart disease
Neurological history ( Parkinson's, epilepsy, narcolepsy)
Metabolic disorders (diabetes, thyroid diseases, etc.)
Drugs (antihypertensive, antianginal, antidepressant, antiarrhythmic, diuretics)
and alcohol-cigarette-substance use habits.
After the initial evaluation by asking these questions, strong ideas can be obtained about what causes syncope. However, examinations and evaluations of different branches are often required.
The patient who is admitted to the hospital with fainting or temporary loss of consciousness is usually evaluated by cardiology, neurology or sometimes psychiatry departments. After the initial evaluation, it is determined whether the loss of consciousness is a real syncope, the most likely causes are revealed, and tests are performed to confirm the diagnosis or rule it out.
In syncope evaluation; ECG, Echocardiography, Stress test, Rhythm Holter, short or long term event recorders, Tilt-Table test, Electrophysiological Study (EPS) and some neurological tests (EEG, brain tomography or MRI). ) may be needed
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