A Family Doctor's Tale - SYNCOPE

DOC I HAVE SYNCOPE


Syncope is a temporary loss of consciousness resulting from inadequate cerebral blood supply.

It is also called fainting.

It can occur at all ages but is more common in the elderly.


The Causes of syncope are:
A.Vasomotor:
1.Vagal slowing of heart and reduction of blood pressure from fear, severe pain, the sight of blood, prolonged standing  or psychogenic disturbance

2.Hemorrhage or circulatory fluid loss from burns resulting in a fall in blood pressure and reduced blood flow to the brain


3.Postural hypotension  - blood pressure drops from sleeping or sitting position to upright position and less blood flows to the brain causing fainting


4.Vasoactive drugs such as anti-hypertensive (prazosin, methyl dopa) and heart medicines(nitrates, adrenergic blockers) also affect the blood flow to the brain


5.Carotid sinus compression from turning of the head or wearing a neck collar affects the blood flow of the main artery to the brain ( the carotid artery)


B.Cardiac:
1.Asystole or heart blockage - causes a slow down of the heart resulting a reduction of blood flow to the brain.

There is fainting with or without fits.

It is also called Adams–Stokes disease.

2.Sudden arrhythmias with high ventricular rate also affects the blood flow to the brain and fainting


3.Heart valve prosthesis - the ball valve prosthesis of the heart sometimes block blood flow to the brain


4.Aortic stenosis with exertion affects the blood flow from the aorta of the heart to the body including the brain


5.Cardiogenic shock following myocardial infarction - a heart attack weakens the heart muscle to squeeze blood out of the heart resulting in shock and fainting


6.Sudden cardiac compression as in pericarditis may cause the same problem as myocardial infarction


Signs and Symptoms of Syncope
A.Vasomotor:
Symptoms:
1.cold sweats, pallor, yawning,

2.Urge to urinate or defecate can sometimes cause fainting


3.low blood pressure from drugs, loss of sweats, salts and fluids


4.dilated pupils

5.Drug therapy such as adrenagenic blockers

B.Cardiac:
1.ECG evidence of arrhythmia, heart block, asystole, or myocardial infarction

2.history of heart ball valve prosthesis, aortic stenosis or chest injury

The complications of Syncope are:

1.head injury from falls


2.fractures also from falls in elderlies


Treatment of Syncope is by the following :



1. Patients with postural or psychogenic syncope recover in recumbent position

2.Cardiac syncope from myocardial infarction needs the patient to be hospitalized and managed in cardiac care unit

3. heart blocks or asystole may need pacemaker implantation

4.Tachycardia with arrhythmia must be treated with special medicines to slow the heart

5.review drug therapy and dosage of potentially causative medicines such as adrenergenic blocking drugs, beta blockers or vasodilators such as nitrates

Prognosis:
1.depends on cause -vasomotor are less serious than cardiac.

2.it may present as a life threatening condition requiring immediate treatment in cardiac syncope