Syncopal conditions are 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 examined in more detail in order to identify the most common causes and to clarify methods of assistance and prevention.
Definition of a concept
Syncope is the name of the syncope from the Latin word "syncope". Fainting can occur in people of different ages. If we analyze the statistics and polls, then about a third of people at least once in their lives fainted. It is necessary to strictly distinguish between an epileptic seizure and a fainting state, since these pathologies require completely different types of treatment.
Most of this pathology occurs due to the imbalance in the activity of the autonomic nervous system, which is responsible for controlling the work of internal organs and blood vessels. Therefore, often syncopal conditions occur during overload, 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. Blood flow to the brain can be affected by: a decrease in vascular wall tone, a drop in blood pressure and heart rate, a decrease in cardiac output, spastic changes in the vessels of the head and neck, and a sharp decrease in blood glucose.
Unfortunately, in almost half of cases, the underlying cause of syncope cannot be established due to the short-term changes in the vascular and nervous system.
Coding
The syncope according to ICD-10 is indicated by R55. This classification is international and is used to code diseases in medical records and disability sheets in the appropriate columns. The 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 specialties should know them. The syncopal state code on the sick leave will look like R55 only, and all other sections are excluded from this section, since they are already related to other pathological processes.
Reasons for fainting
The causes of the syncope are many-sided, but they can be systematized:
- Short-term circulatory disorders associated with reflex changes in the functioning of organs and systems. 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 heart contractions slows down, blood vessels expand, blood pressure drops, so the cardiovascular system cannot provide the necessary amount of oxygen and nutrients to the brain, and it turns off.
- A significant advantage in the direction of parasympathetics can occur with severe unrest, stress, fear, the form of blood, in the dentist's office.
- Reflex irritation of carotid sinuses can occur with severe coughing, sneezing, swallowing, during intense physical exercise, playing wind instruments.
- Wearing tight collars, ties, scarves, as well as a long vertical stay in a stuffy, long aired room can contribute to fainting of this type.
- The orthostatic genesis of syncope is associated with a sharp change in body position. More often this happens when a person gets up after a long lying, sleep. In this case, insufficient blood supply to the brain is obtained due to the fact that blood for various reasons does not have time to reach the brain as fast as the body needs at the moment.
- This condition requires a particularly thorough examination to exclude a serious pathology: Parkinson's disease, diabetic neuropathy, neuropathy with amyloidosis, Addison's disease, multiple systemic atrophy.
- Such fainting also occurs due to a decrease in the volume of circulating blood as a result of bleeding of various nature or dehydration caused by diarrhea or vomiting.
- Taking certain medications can lead to a syncopal state (drugs for arterial hypertension, including diuretics, as well as nitrates for the treatment of angina pectoris, levodopa drugs).
- Fainting, caused by disturbances in the heart, occurs in about one fifth of people suffering from loss of consciousness.
- The violation of the flow of blood and oxygen to the brain in this case is associated with cardiac pathology, manifested in the form of arrhythmias of various nature, blockade, tachycardia, bradycardia, impaired functioning of artificial pacemakers, and the use of antiarrhythmic drugs.
- Diseases affecting the heart valves (stenosis, insufficiency) impede the delivery of oxygen to brain cells, which can lead to cardiogenic syncope.
- The same reason for fainting with other organic pathologies of the heart muscle and blood vessels (angina pectoris, heart attack, cardiomyopathy, aneurysm, tumors, pericarditis, myocarditis, pulmonary embolism).
- Syncopal conditions in neurology can be cerebrovascular in nature. In neurological practice, there is the concept of vertebro-basilar 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 concerned about dizziness, and with a significant deterioration in the blood supply to the brain, a syncope is possible.
- The "stealing" syndrome can occur with pathological narrowing or blockage of the subclavian vein, which, in addition to dizziness and double vision, can lead to a fainting fit.
- Elderly patients may suffer from fainting conditions due to disruption of the brain vessels associated with spasms, which leads to hypoxia.
- The action of elevated temperatures (heat stroke) dilates the blood vessels of the body, the blood goes to the periphery, which leads to insufficient nutrition of brain cells and the development of cerebrovascular fainting.
Classification of syncope
Fainting can be classified according to various criteria. Most often, the types of syncopal conditions are considered depending on the causes of their causing:
1. Reflex fainting:
- Vasomotor associated with impaired vascular regulation of the autonomic nervous system.
- Vagal, that is, due to the predominant action of the vagus nerve on the body.
- Carotid arising due to direct or indirect effects on the sensitive carotid sinus.
2. Orthostatic syncope:
- Primary (with diseases of the nervous system, such as Parkinson's disease).
- Secondary (with pathologies of internal organs that violate peripheral nervous regulation, such as diabetic neuropathy).
- Syncopal conditions after a change in body position and load.
- Fainting after eating.
- Fainting after taking certain medications (adrenergic blockers, diuretics, nitrates).
- Syncope after drinking alcohol.
- Fainting due to a decrease in circulating blood volume.
3. Cardiogenic syncope:
- Associated with cardiac arrhythmias.
- Conductivity related.
- In case of malfunction of the pacemaker.
- Due to the medicinal effect of antiarrhythmic drugs.
- Fainting associated with heart valve disease.
- Syncope after or during a heart attack.
- Fainting due to organic lesions of the heart muscle (myocarditis, myocardial dystrophy, myxoma, angina pectoris).
- Syncopal paroxysms due to damage to large vessels (aortic aneurysm, pulmonary thromboembolism).
4. Cerebrovascular fainting:
- With vertebro-basilar insufficiency.
- Fainting with the "stealing" syndrome.
- With discirculatory encephalopathy of vascular origin.
- With heat stroke.
Clinical manifestations in adults
Syncope Syndrome clinically goes through three stages:
- The pre-syncope phase is characterized by general weakness, malaise, nausea, abdominal pain, darkening in the eyes. The skin turns pale, sweating intensifies. Patients are often worried about dizziness, headache, discomfort in the heart, a feeling that there is not enough air, a rapid heartbeat. This condition does not necessarily occur before passing out and can last up to several minutes. At this moment, the person is conscious and remembers what is happening to him.
- Syncope lasts an average of up to 20 seconds. There is a lack of consciousness. All the muscles of the body relax, the pupils dilate, the skin becomes pale and moist with sweat, or it can be dry.
- The post-syncope phase is characterized by a return of consciousness. A person can be lethargic and inhibited. Often he is worried about headaches, confusion, dizziness, weakness, discomfort in the chest. The condition after the syncopal state most often lasts no more than half an hour.
Fainting in children
Syncope in children and adolescents is a very serious problem and occurs in 15% of people under 18 years of age.
Most often, in childhood, reflex syncope occurs associated with unpleasant situations for children, stimulation of the carotid sinus, vagal hyperfunction. Cardiogenic syncope can be associated with heart defects, arrhythmias (about 11%).
Be sure to differentiate fainting with an epileptic seizure. When questioning a child, it is also necessary to interview witnesses of loss of consciousness, to clarify what symptoms preceded him, how quickly all functions restored.
Clinical manifestations in children are similar to what occurs with fainting in adults. Before a syncope, the child may complain of a feeling of weakness, lack of air, ringing in the ears, darkening in the eyes, nausea, numbness of the hands and feet. In the post-syncope period, the child can be very scared and start to cry. It is necessary to calm and explain to the baby what is happening.
Diagnosis of syncope
In order to make an accurate diagnosis, the specialist should inquire in great detail about all cases of loss of consciousness, what preceded them, how these episodes went, how the patient recovered and recovered in the post-syncope period. For this, a witness should be interviewed for syncope, since the patient himself has an idea of only the part that preceded him and the period after the resumption of consciousness.
Blood pressure is measured using a tonometer in a resting state while lying and standing. It is better to take a threefold measurement.
Electrocardiography will help to evaluate the rhythm of heart contractions, the absence of blockade, ischemic manifestations, and pulse rate.
When abnormalities are detected, daily monitoring of the work of the heart is shown using an ECG apparatus connected to a person who must perform all his usual duties and loads.
With a deviation in daily monitoring or suspicion of any organic pathology of the heart, an ultrasound examination should be performed.
A complete blood count can detect anemia, which can contribute to a fainting condition.
To exclude or confirm the reflex nature of fainting, people under 40 can be tested with a massage of the carotid sinus in the supine position under the control of an ECG and blood pressure measurements. This place on the neck, where the common carotid artery is divided into internal 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. Persons who respond to massage with a pronounced decrease in both indicators (systolic pressure drop of less than 50 mm Hg and no ventricular contractions for three seconds) have hypersensitivity to this node, which can cause reflex syncope, for example, with a tight collar or tie.
Orthostatic tests are performed with suspected syncope, having a relationship with a change in body position. An active dynamic transition from a lying position to an upright position is performed.
Differential diagnosis
Differentiate syncope 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.
- Cataplexic state.
- Pseudo-syncope with psychosis.
- Hysterical "swoon."
- Panic attacks.
To confirm or exclude the above pathological manifestations, an examination should be deepened. An ultrasound examination of the neck vessels, rheoencephalography for the study of cerebral blood flow is carried out. Electroencephalography eliminates the convulsive nature of the disease. Computed tomography or magnetic resonance imaging of the brain shows its structure, vascular disorders in the brain, detects tumors and cysts, as well as developmental abnormalities.
A biochemical blood test reflects metabolism. A study of the level of hormones in the blood helps to detect endocrine pathology.
If all examinations are completed and if it is difficult to identify the cause, the patient should be referred to a psychotherapist or psychiatrist.
Treatment and prevention
Syncopal conditions are an occasion to consult a specialist. Treatment can be either medication or without drugs.
In syncopal conditions, recommendations for further patient behavior will depend on the cause of the syncope.
Lifestyle changes with reflex genesis associated with avoiding syncope-provoking situations will help reduce their number to a minimum. It should be less in stuffy rooms, not having the ability to ventilate them, wear loose clothing that does not stimulate the carotid zone on the neck.
With frequent reflex syncope, which significantly worsen the lives of patients or prevent them from leading the way of life that they would like (driving a car, working at height, a sports career), they should resort to their treatment.
Cross-arm and leg exercises can increase blood pressure for a while to avoid syncope.
There are physical methods for training patients with orthostatic fainting, which can increase the time spent in an upright position (title trainings). Such training is carried out gradually over a long time.
Medications to stabilize the autonomic nervous system, including antidepressants, give temporary and conflicting results. Effective in concomitant neurotic disorders, including phobias and panic attacks.
Cardiogenic syncope is treated along with the underlying cause that provokes them. It will be appropriate to contact the center of syncope and cardiac arrhythmias. Conducted drug therapy, as well as the use of pacing techniques.
Clinical recommendations for syncope in the elderly come down 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 the same person is affected by several threats. The medicines taken by such a patient should be reviewed with a view to stimulating the risk of developing a syncope.
Maintaining a healthy lifestyle with proper nutrition, refusal from harmful addictions, regular physical education and outdoor recreation will be a good help in the treatment of fainting attacks of any etiology.
Complications
Since syncopal conditions are disturbances in the functioning of the nervous system associated with many reasons, complications can be different in terms of danger to life and the involvement of organs and systems.
Complications of fainting are:
- Injuries from a fall.
- Cardiac Death Syndrome (cardiac arrest).
- Asphyxia in the lowering of the tongue.
- Impaired memory and thought processes with frequent fainting due to decreased blood perfusion in the brain (especially in elderly patients).