Syncope is short-term episodes of loss of consciousness due to vascular and other pathological problems in the brain. Due to the prevalence of this problem among the population, this issue should be considered in more detail to identify the most common causes, clarify methods of assistance and prevention.
Definition of concept
Syncope is the name of the syncope from the Latin word "syncope". Fainting can occur in people of all ages. If we analyze statistics and polls, then about a third of people fainted at least once in their lives. An epileptic seizure and fainting should be strictly distinguished, since these pathologies require completely different types of treatment.
Most of this pathology occurs due to imbalance in the activity of the autonomic nervous system, which is responsible for controlling the work of internal organs and blood vessels. Therefore, syncope often occurs during overloads, stress, adverse working conditions.and uncomfortable body position.
The development of fainting occurs on average due to a decrease in blood flow to the brain by 30% or more, which leads to oxygen starvation and loss of consciousness. The following can affect the flow of blood to the brain: a decrease in the tone of the vascular wall, a drop in blood pressure and heart rate, a decrease in cardiac output, spastic changes in the vessels of the head and neck, a sharp decrease in blood glucose.
Unfortunately, in almost half of the cases, the underlying cause of fainting cannot be determined due to the short-term changes in the vascular and nervous system.
Encoding
Syncope according to ICD-10 is designated R55. This classification is international and is used to code diseases in medical records and disability certificates in the appropriate columns. Syncope according to ICD-9 has not been encrypted in the Russian Federation since 1999 after the tenth revision of the classification came into force. These ciphers are more often used by neurologists, but doctors of other speci alties should also be aware of them. The syncope code on the sick leave will only look like R55, and all other rubrics are excluded from this section, as they are already related to other pathological processes.
Causes of fainting
The causes of syncope are many-sided, but they can be systematized:
- Short-term circulatory disorders associated with reflex changes in the functioning of organs andsystems. This is possible with increased work of the parasympathetic nervous system, that is, the predominance of the influence of the vagus nerve on the heart and blood vessels. In this case, the number of heartbeats slows down, blood vessels dilate, blood pressure drops, so the cardiovascular system cannot provide the necessary amount of oxygen and nutrients to the brain, and it turns off.
- Significant preponderance towards parasympathetics can occur with strong excitement, stress, fear, the sight of blood, in the dentist's office.
- Reflex irritation of the carotid sinuses can occur with severe coughing, sneezing, swallowing, during intense exercise, playing wind instruments.
- Contribute to this type of fainting can be wearing tight collars, ties, scarves, as well as a long vertical stay in a stuffy, unventilated room for a long time.
- Orthostatic genesis of syncope is associated with a sudden change in body position. Most often this happens when a person gets up after a long lying down, sleep. In this case, there is insufficient blood supply to the brain due to the fact that for various reasons the blood does not have time to reach the brain as quickly as the body needs at the moment.
- This condition requires particularly careful examination to rule out serious pathology: Parkinson's disease, diabetic neuropathy, amyloidosis neuropathy, Addison's disease, multiple system atrophy.
- Such syncope also occurs due to a decrease in volumecirculating blood as a result of bleeding of various nature or dehydration caused by diarrhea or vomiting.
- Some medications can cause syncope (drugs for arterial hypertension, including diuretics, as well as nitrates for the treatment of angina pectoris, levodopa drugs).
- Faints, caused by abnormal heart function, occur in about one-fifth of people suffering from blackouts.
- Violation of the supply of blood and oxygen to the brain in this case is associated with cardiac pathology, manifested in the form of arrhythmias of various nature, blockades, tachycardia, bradycardia, impaired operation of artificial pacemakers, and the use of antiarrhythmic drugs.
- Diseases affecting the heart valves (stenosis, insufficiency) make it difficult to deliver oxygen to brain cells, which can lead to cardiogenic syncope.
- The same cause of fainting in other organic pathologies of the heart muscle and blood vessels (angina pectoris, heart attack, cardiomyopathy, aneurysm, tumors, pericarditis, myocarditis, pulmonary embolism).
- Syncope in neurology can be of a cerebrovascular nature. In neurological practice, there is the concept of vertebrobasilar insufficiency, which includes the pathology of the vessels of the vertebral and cerebral basilar arteries due to osteochondrosis of the cervical spine. In this case, patients are worried about dizziness, and with a significant deterioration in the blood supply to the brain, a syncope is possible.
- Stealing syndrome canoccur with pathological narrowing or blockage of the subclavian vein, which, in addition to dizziness and double vision, can lead to fainting.
- Elderly patients may suffer fainting due to cerebrovascular accident associated with spasms, resulting in hypoxia.
- The action of elevated temperatures (heatstroke) dilates the blood vessels of the body, the blood goes to the periphery, which leads to malnutrition of brain cells and the development of cerebrovascular syncope.
Classification of syncope
Fainting can be classified according to various criteria. Most often, the types of syncope are considered depending on the causes of their causes:
1. Reflex syncope:
- Vasomotor associated with impaired vascular regulation of the autonomic nervous system.
- Vagus, that is, due to the predominant action of the vagus nerve on the body.
- Carotid, arising from direct or indirect effects on the sensitive carotid sinus.
2. Orthostatic syncope:
- Primary (in diseases of the nervous system such as Parkinson's).
- Secondary (with pathologies of internal organs that disrupt peripheral nervous regulation, such as diabetic neuropathy).
- Syncope after a change in body position and load.
- Funning after eating.
- Fainness after taking certain medications (blockers, diuretics, nitrates).
- Syncope after takingalcohol.
- Fooning due to reduced blood volume.
3. Cardiogenic syncope:
- Associated with heart rhythm disturbances.
- Associated with conduction disorders.
- When the pacemaker malfunctions.
- Due to the medicinal effect of antiarrhythmic drugs.
- Failing due to valvular disease.
- Syncope after or during a heart attack.
- Fooning due to organic lesions of the heart muscle (myocarditis, myocardial dystrophy, myxoma, angina pectoris).
- Paroxysmal syncope due to damage to large vessels (aortic aneurysm, pulmonary embolism).
4. Cerebrovascular syncope:
- With vertebrobasilar insufficiency.
- Fainting with steal syndrome.
- With dyscirculatory encephalopathy of vascular origin.
- For heat stroke.
Clinical manifestations in adults
The syncope syndrome clinically goes through three stages:
- The pre-syncope stage is characterized by general weakness, malaise, nausea, abdominal pain, darkening of the eyes. The skin turns pale, sweating increases. Patients are often worried about dizziness, headache, discomfort in the heart, feeling that there is not enough air, heart palpitations. This condition does not necessarily occur before fainting and can last up to several minutes. At this moment the person isconscious and remembers what happens to him.
- Syncope lasts an average of 20 seconds. There is no consciousness. All the muscles of the body relax, the pupils dilate, the skin becomes pale and damp with sweat, or may be dry.
- The post-fainting stage is characterized by the return of consciousness. The person may be lethargic and lethargic. Often he is disturbed by headaches, confusion of thoughts, dizziness, weakness, discomfort in the chest. The state after syncope most often lasts no more than half an hour.
Funning in children
Syncope in children and adolescents is a very serious problem and occurs in 15% of people under 18.
Most often in childhood there are reflex syncope associated with situations unpleasant for children, stimulation of the carotid sinus, vagal hyperfunction. Cardiogenic syncope can be associated with heart defects, arrhythmias (about 11%).
It is imperative to differentiate syncope from an epileptic seizure. When questioning the child, it is also necessary to interview witnesses of the loss of consciousness, to clarify what symptoms preceded him, how quickly all functions were restored.
The clinical manifestations in children are similar to what happens with fainting in adults. Before syncope, the child may complain of a feeling of weakness, lack of air, ringing in the ears, darkening of the eyes, nausea, numbness of the arms and legs. In the post-syncope period, the child may be very frightened and start crying. Necessarysoothe and explain to the baby what is happening.
Diagnosis of syncope
In order to make an accurate diagnosis, the specialist should ask in great detail about all cases of loss of consciousness, what preceded them, how these episodes went, how the patient came to and recovered after the fainting period. To do this, it is necessary to conduct a survey of a witness of a syncopal state, since the patient himself has an idea only of the part that preceded him and the period after the resumption of consciousness.
Blood pressure is measured using a tonometer in a calm state in the supine and standing position. It is better to measure three times.
Electrocardiography will help assess the rhythm of heart contractions, the absence of blockades, ischemic manifestations, and pulse rate.
When deviations are detected, daily monitoring of the heart is shown using an ECG device connected to a person who must perform all his usual duties and loads.
If there is a deviation in 24-hour monitoring or suspicion of any organic pathology of the heart, an ultrasound examination should be performed.
CBC can detect anemia, which can contribute to fainting.
To exclude or confirm the reflex nature of fainting, people under 40 years old can be tested with carotid sinus massage in the supine position under the control of ECG and blood pressure measurement. This is the place in the neck where the common carotid artery divides intointernal and external, has a large accumulation of receptor cells responsible for the innervation of blood vessels and the heart. Their irritation leads to the activation of the parasympathetic nervous system, a slowdown in heart rate and a drop in blood pressure. Individuals who respond to massage with a pronounced decrease in both indicators (a drop in systolic pressure of less than 50 mm Hg and no ventricular contractions for three seconds) have hypersensitivity of this node, which can cause reflex syncope, for example, with a tight collar or tie.
Orthostatic tests are performed in cases of suspected syncope associated with a change in body position. An active dynamic transition from supine to standing is in progress.
Differential Diagnosis
Differentiate fainting with the following conditions:
- Metabolic problems that lead to impaired consciousness, up to coma (hypo- and hyperglycemia, hypoxia, hypercapnia, hyperventilation).
- Epilepsy.
- Toxic effect of various substances.
- Transient ischemic attacks.
- Cataplexy.
- Pseudo syncope in psychosis.
- Hysterical "faint".
- Panic attacks.
To confirm or exclude the above pathological manifestations, the examination should be deepened. An ultrasound examination of the vessels of the neck, rheoencephalography is performed to study cerebral blood flow. Electroencephalography allows to exclude the convulsive nature of the disease. Computed tomography or magnetic resonance imaging of the brain shows its structure, vascular disorders in the medulla, detects tumors and cysts, as well as developmental anomalies.
Biochemical blood test reflects the indicators of metabolism. The study of the level of hormones in the blood helps to detect endocrine pathology.
If all examinations are passed and the cause is difficult to find, the patient should be referred to a psychotherapist or psychiatrist.
Treatment and prevention
Syncope is a reason to see a specialist. Treatment can be with or without medication.
In syncope, recommendations for further behavior of patients will depend on the cause of syncope.
Change in lifestyle during reflex genesis, associated with avoiding situations provoking syncope, will help to reduce their number to a minimum. You should be less in stuffy rooms, not being able to ventilate them, wear loose clothing that does not stimulate the carotid zone on the neck.
For frequent reflex syncope, which significantly worsen the life of patients or prevent them from leading the life they would like (driving a car, working at height, sports career), they should be treated.
Exercising with crossing arms and legs can increase blood pressure for a while to avoidsyncope.
There are physical methods of training patients with orthostatic syncope to increase the time spent in an upright position (title training). Such training is done gradually over a long period of time.
Medications to stabilize the autonomic nervous system, including antidepressants, give temporary and inconsistent results. Effective in concomitant neurotic disorders, including phobias and panic attacks.
Cardiogenic syncope is treated along with the underlying cause. It would be appropriate to contact the center of syncope and cardiac arrhythmias. Drug therapy is being carried out, as well as the use of pacing techniques.
Clinical recommendations for syncope in the elderly are reduced to therapy aimed at the cause of syncope. Often the causes are orthostatic, carotid and arrhythmic factors, as well as vascular pathology. It happens that several threats act on the same person. Medications taken by such a patient should be reviewed for stimulating the risk of developing syncope.
Maintaining a he althy lifestyle with proper nutrition, avoidance of harmful addictions, regular exercise and outdoor recreation will be a good help in the treatment of fainting spells of any etiology.
Complications
Since syncope is a disorder in the functioning of the nervous system associatedwith many causes, then their complications may be different in terms of danger to life and the involvement of organs and systems.
Complications of fainting are:
- Fall injuries.
- Cardiac death syndrome (cardiac arrest).
- Asphyxia due to retraction of the tongue.
- Impaired memory and thought processes with frequent syncope due to reduced blood perfusion in the brain (especially in elderly patients).
