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The maximum incidence of this manifestation is reached within the population aged between 15-20 years and at elderly people, over 70 years old. The etiology of the fainting state is generally specific for age categories, thus, in young people, this is especially of the vasovagal type, while the elderly frequently associate this manifestation with the evolution of cardiovascular diseases.
In certain situations, the state of fainting can be preceded by a series of manifestations felt by the patient in the form of a feeling of “empty head”, nausea, blurred vision or hot flashes. These manifestations are encountered infrequently in people with a personal history of syncope, but when they occur, they can prevent the patient who acts instinctively and avoids a possible fall injury.
Syncope is more common during the warm season due to the increased ambient temperatures that favor the occurrence of hydroelectrolytic losses and dehydration through excessive sweating. Dehydration, in turn, triggers certain physiopathological mechanisms that involve hypovolemia and hypotension, which, along with vasodilatation, favors depriving the brain of blood and oxygen. Syncope due to exposure to high temperatures associates short-term loss of consciousness and it goes away after the patient adopts the decubitus position (lying horizontally) which favors reoxygenation of the brain.
Symptoms of syncope
Before loss of consciousnessthe patient can associate a series of manifestations frequently represented by:
Integumentary pallor The feeling of “empty head” Limitation of peripheral vision The feeling of nausea The feeling of heat Excessive sweating followed by the feeling of cold due to its evaporation from the surface of the integument Blurred vision.
During vasovagal syncope, the person may present abnormal movements of the limbs in the form of jerks, weak filiform pulse and dilated pupils.
Recovery after syncope usually begins in less than 1 minutebut it is recommended that the person not return to the orthostatic position (not stand up) for at least 30 minutes to prevent the risk of fainting due to orthostatic hypotension.
First aid in case of syncope
The first aid given in the case of syncope involves placing the patient in a recumbent position with the head turned to the side to prevent mechanical asphyxiation by the tongue falling and the slight elevation (lifting) of the lower limbs to facilitate the function of the heart pump in order to reoxygenate the brain.
The person in a state of fainting it can be stimulated by lightly hitting the cheeks and splashing with cold water, until it recovers from the state of unconsciousness. In the event that the person is not responsive to verbal (when called by name) or physical stimuli, it is recommended to call the 112 emergency service.
In the situation where the person regains his state of consciousness, he must be kept in the supine position until the senses are fully recovered, with the progressive return to sitting and later, to orthostatism (in a vertical position).
Types of syncope
Innocuous syncope that resolves spontaneously with the patient’s full recovery they are also known as neurally mediated syncope, vasovagal syncope or neurocardiogenic type syncope.
Orthostatic syncope the recurrence negatively affects the quality of life of the patient, who frequently complains of severe fatigue and the feeling of “brain fog” that interferes with the smooth performance of daily activities. Orthostatic syncope is considered to be a benign pathology that does not endanger the patient’s life, but in the elderly, this manifestation is an important cause of injury through falling and requires specialized medical care, especially in the situation where it favors the formation of bone fractures.
Cardiac syncope can be determined by a multitude of factors including: Vascular pathologies with chronic evolution (heart failure) Arrhythmias Cardiomyopathies of various etiologies Aorta dissection Acute cardiac ischemia.
These conditions cause the appearance of pathological mechanisms that disturb the function of the cardiac pump and favor the establishment of hypoperfusion (lack of blood and oxygen) at the cerebral level, with the transient loss of consciousness.
Neurological syncope
Neurological syncope is preceded by a prodromal syndrome involving:
Vertigo (dizziness) Dysarthria (difficulties speaking) Dysphagia (difficulty swallowing) Diplopia (double vision) Ataxia (lack of coordination of body movements).
Cerebral hypoperfusion that determines the onset of neurological syncope can be due to a transient cerebral ischemic attack – TIA or complete – AVC, which evolves with difficulty maintaining postural balance and speech disorders in the case of temporary obstruction of the cerebral vasculature (transient ischemic accident) or with increased intensity headache in the case of a stroke.
Cardiac syncope
The main causes involved in the occurrence of cardiac syncope are represented by:
Heart rhythm disorders: bradycardia (decrease in heart rate below 30 beats/minute), tachycardia (increase in heart rate). Cardiac and pulmonary pathologies: pulmonary embolism, aortic dissection, pulmonary hypertension, acute myocardial infarction.
Syncope of cardiac etiology that manifests itself in conditions of physical exertionsignals the possibility of the existence of a cardiac rhythm disorder and requires a thorough clinical examination performed by the cardiologist for the diagnosis and appropriate treatment of the underlying pathology.
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The difference between syncope and circulatory collapse
Circulatory collapse or the state of shock is due to the sudden drop in blood pressure, being followed by hypoxia both at the level of the vital organs and the central nervous system. Collapse is a medical emergency whose spontaneous evolution can be disastrous for the patient in the absence of specialized care. The main manifestations of collapse or cardiovascular shock are represented by:
State of temporal-spatial confusion Anxiety Excessive sweating Tachypnea (accelerated respiratory rate) Tachycardia Loss of consciousness.
Cardiovascular shock is due the impossibility of the heart to supply the necessary blood and oxygen the body in order to maintain vital metabolic processes. Pump failure can be secondary to extensive trauma, an allergic reaction, septic conditions, extensive burns, acute dehydration or acute myocardial infarction.
Syncope treatment
In most situations, vasovagal syncope it resolves spontaneously and completely and does not require specific treatment, but it can be useful to talk with the specialist to identify and avoid in the future the causes that determined the appearance of fainting.
Recurrent syncope which affects the patient’s quality of life, benefits from drug treatment for normalization of low voltage values by administering serotonin reuptake inhibitors. Performing regular exercise improves blood circulation and prevents episodes of fainting in hypotensive people, along with wearing compression stockings with the role of increasing the return of venous circulation.
Medical intervention in the presence of recurrent syncope is indicated in the situation where:
The patient was previously diagnosed with a cardiac pathology or has risk factors for pulmonary thromboembolism. Syncope affects the patient’s state of consciousness for more than 2 minutes – the patient does not fully recover after regaining consciousness. The triggering factors that determined the patient’s loss of consciousness cannot be identified. After regaining consciousness, the patient complains of heart-type pain or has motor deficits, speech difficulties or altered mental status.
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2023-07-20 22:06:02
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