Fainting or Syncope

Syncope is a state of sudden loss of consciousness and tone that passes without therapy.

The patient falls to the ground due to the decreased general and transient blood flow to the brain.


Causes of fainting

In many cases, the cause of fainting is unknown, but syncope can be caused by:

  • Fear
  • emotional trauma,
  • Ache
  • Pregnancy
  • a drop in blood pressure (for example, after blood donation or due to heavy menstrual bleeding),
  • decrease in oxygen pressure in the blood (hypoxic syncope),
  • Long fasting (can also lead to nocturnal fainting),
  • hyperventilation (rapid breathing),
  • Dehydration
  • physical exertion,
  • Strong coughing shocks,
  • Tachycardia
  • strain during bowel movements,
  • Epilepsy
  • Very high fever,
  • freezing to death (also causes pallor on the face and blue or purple lips),
  • Drugs
  • Alcohol abuse.

Drugs that lower blood pressure also increase the tendency to faint.

Syncope can be caused by one of the following diseases:

  • Diabetes
  • Infarct
  • Arrhythmia
  • Panic attack

Causes of fainting in children

Syncope that occurs in children is caused by a short-term lack of oxygen in the brain.

Vasovagal syncope is a disorder that occurs in children due to stress, anxiety or pain. Fainting is caused by various conditions, including:

  • Arrhythmia (abnormal heart rhythm)
  • Kawasaki disease,
  • ischemic cardiomyopathy,
  • Eisenmenger syndrome,
  • Primary pulmonary hypertension,
  • lesion or head trauma,
  • Hysteria
  • Hyperventilation
  • Stroke
  • Dehydration.

Presyncope or fainting

Presyncope is a very common condition in which the patient feels unconscious, but may lie down before falling.

In the case of presyncope, the person remembers what happened before fainting.

The symptoms that allow the patient to be aware that he is fainting are the prodromal symptoms that are remembered during the anamnesis:

  • Head emptiness, weakness, eye fibrillation/ringing in the ears, visual and/or hearing impairment → These are symptoms of lack of blood flow to the brain,
  • Nausea, vomiting, abdominal pain, violent sweating, dry mouth → These are symptoms of activation of the vagus nerve, so one must then suspect a vasovagal syncope,
  • Sudden loss of consciousness, palpitations, chest pain, → These are symptoms that may be related to cardiac syncope,
  • Delirium → Cerebral hypoperfusion leads to temporary mental confusion, which can precede loss of consciousness.

Symptoms of fainting or syncope

Before a loss of consciousness, the following symptoms may appear:

  • Yawn
  • Sudden cold sweat,
  • nausea and the feeling of vomiting,
  • deep breathing,
  • Confusion
  • dizziness or spinning vertigo,
  • Numbness
  • blurred vision,
  • ringing in the ears (tinnitus),
  • blocked ears,
  • headache (rare),
  • Weakness.

When you fall to the ground, your head and heart are at the same level. The heart doesn’t have to pump blood against gravity to get it to the brain.

Syncope lasts about 20 seconds.

If a person faints and does not regain consciousness after 2 minutes, the ambulance must be called.

After fainting, the person shows confusion, fatigue and weakness for over 20-30 minutes.

When to worry?

Fainting can be confused with a stroke. A stroke occurs when the blood flow to the brain is interrupted.

The number 112 (emergency doctor) should be called immediately if there is a suspicion that a person is suffering a stroke.

The symptoms of a stroke can be memorized with the English word FAST (Face-Arms-Speech-Time = Face-Arms-Speech-Time).

Face: The affected person may not smile and corners of the mouth and one eye may be paralyzed.

Arms: A person with a stroke cannot raise their arms and keep them outstretched.

The affected person feels the arm as numb.

Language: The person has difficulty speaking.

Driving and Syncope

For someone who suffers from fainting spells, driving is dangerous. Each state imposes restrictions depending on the severity of the disease. You can contact the responsible driver’s license office for more information.

Test and diagnosis of fainting or syncope

Diagnosis of transient loss of consciousness

According to the guidelines of the ESC – 2009, the first 4 basic measures that must be carried out in a patient with loss of consciousness are:

  1. Anamnesis
  2. Physical examination,
  3. control of arterial blood pressure while standing and lying down,

However, this scheme is not always adhered to and a skull CT is immediately performed in the emergency room: an expensive and, from some diagnostic point of view, useless examination.

The characteristic features of syncope must be verified

Syncope in orthostatic hypotension → orthostasis in the past.

Classical vasovagal syncope

The diagnosis is confirmed if the patient meets some criteria:

  1. The episode occurred after one of these events:
    • After physical exertion,
    • After intense heat,
    • After frightening (strong emotion),
    • When seeing blood,
    • During or after an injection (also vaccination),
    • In case of pain,
    • In a crowded room.
  2. Inconspicuous neurological examination findings,
  3. Unobtrusive test for orthostatic hypotension,
  4. ECG inconspicuous.

Syncope in hypotension

Occurs during or after a meal.

Situational syncope – occurs:

  • During bowel movements (for example, in a constipated person), vomiting, urination (especially if the person has prostate enlargement), coughing, sneezing
  • When swallowing

Prodromal symptoms should be noted.

Characteristic test: Valsalva maneuver, which is a forced exhalation against closed mouth and nose.

Cardiac Syncope

In order to break down the risk of cardiac syncope, the following parameters are taken into account:

  • Age > 45 years
  • Previous history of heart failure
  • Previous ventricular arrhythmias
  • Conspicuous ECG

If the patient suffers syncope during a heart attack, the diagnosis is easy to make.

In differential diagnosis, it is necessary to exclude:

1) Diseases with total or partial loss of consciousness without reduced general circulatory disorder:

  • Epilepsy
  • metabolic disorders, including hypoglycemia, hypoxia, hyperventilation with hypocapnia
  • Poisoning
  • Vertebrobasilar Transient Ischemic Attack (TIA)

2) Disorders without loss of consciousness:

  • Catalepsy: Very rare disease characterized by immobility and muscular rigidity, in which the patient appears to be asleep, while in reality he is vaguely conscious.
  • Drop Attack: The patient suddenly falls to the ground because his legs fail, but does not suffer any loss of consciousness.
  • Functional: Psychogenic pseudosyncope due to hysteria. Usually, young women are affected. Features of these episodes are:
    • They never fall to the ground when they are alone, because there is no one to ask for help,
    • The patient never has significant bruises.
  • Carotid-related TIA: If an embolus from the carotid artery blocks a cerebral artery, the patient does not lose consciousness, but shows focal neurological deficits.

Difference between Epilepsy and Syncope

Epilepsy Syncope Prolonged tonic clonic seizures that occur along with loss of consciousness Short tonic-clonic seizures that occur after loss of consciousness Monolateral (the epileptic seizure affects only part of the cerebral cortex) Bilateral automatisms (movements of the lips, tick) Nausea, vomiting, massive sweating Tongue bite – aura – post-critical status The person recovers immediately and does not want to go to the Being admitted to hospital Muscle pain No pain Blue discoloration of the skin Skin pallor due to reduced blood circulation

Examination for fainting or syncope

The investigations are:

  • Electrocardiogram (ECG)
  • This examination measures the electrical activity of the heart and examines existing arrhythmias (irregular heartbeat) and other cardiological problems.
  • Echocardiogram
  • This examination is carried out by ultrasound and shows structural malformations of the heart (for example, valve defects).
  • Physical stress test
  • This test examines the heart rhythm during physical exertion. It is done by means of a bicycle ergometer or on the treadmill.
  • Blood test.
  • It serves to detect existing diseases (such as anemia) that cause fainting.
  • Tilt Test
    The tilt table test serves to provoke syncope by tilting the patient.

    • The patient is strapped to a tilting table in a supine position;
    • After 10 minutes, the table is tilted by 60-70 degrees, the patient almost reaches a standing position.
    • The position is maintained for 20 minutes.

If the patient does not faint, the doctor sublingually administers nitroglycerin. This drug has a vasodilating effect on the veins.

The consequences are:

  • The blood accumulates in the lower extremities.
  • The sympathetic nervous system is stimulated to transport the blood to the brain.

During the tilting table examination, the patient experiences strong stimulation of the sympathetic nervous system.

If this stimulation is strong, overactivity of the vagal system with bradycardia and vasodilation occurs.

In susceptible patients, this can trigger vasovagal syncope.

This test also allows the diagnosis of orthostatic hypotension.

During the examination, the vital parameters are checked after 1, 3, 5, 10 and 20 minutes.

Depending on the type of different types of syncope in orthostatic hypotension, the pressure drop can occur at different moments.

The doctor must therefore repeat the measurements 5 times.

Who performs a stress test?

Patients who have syncope during or immediately after exercise.

ECG and monitoring of blood pressure are performed during exercise and during the recovery period.

heart problems exist when syncope occurs during physical exertion; when syncope occurs after exercise, the syncope is triggered by a reflex mechanism.

Other investigations:

  • electroencephalography (EEG),
  • magnetic resonance imaging of the brain,
  • carotid Doppler sonography,
  • Pulmonary scinitgraphy.

What should you do? Therapy for syncope or fainting

What do you have to do in case of fainting?

  • In syncope, blood flow to the head must be supported by placing the legs above heart level.
  • The best position is the supine position, with the legs rested on a chair.
  • Alternatively, you can sit the person down and lower their head between their knees.
  • Remove or loosen tight necklaces, belts or other fitting garments.
  • Leave the person sitting or lying down for 10-15 minutes.
  • Once the person has returned consciousness, have a glass of water to drink.
  • If the person concerned does not breathe, the emergency services must be called immediately on 112.

Measures for people suffering from vasovagal syncope

There are some “counter-pressure maneuvers” that trigger a stimulus in the sympathetic system that blocks the excessive vagus activation that is the cause of syncope:

  1. Squeeze a rubber ball with full force,
  2. Legs overturned, thereby contracting the muscles of the legs and abdomen,
  3. Hook your fingers together and pull your hands apart as hard as possible.

When is fainting an emergency?

Call 112 immediately if someone loses consciousness and:

  • Not breathing,
  • Not regaining consciousness within minutes,
  • has fallen and has an injury or is bleeding,
  • is pregnant,
  • has diabetes,
  • is middle-aged and has had syncope in the past,
  • has an irregular heartbeat,
  • Had chest pain before fainting,
  • has convulsions,
  • has a tongue injury (because he had a mouth lock when his tongue protruded),
  • has urinary and fecal incontinence,
  • has difficulty speaking,
  • has vision loss,
  • Not able to move the body.

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