Syncope is a common clinical syndrome that occurs due to sudden fainting due to insufficient blood supply to the brain. 10-30% of the general population has experienced syncope in their lifetime, some may faint once or twice in a few decades, and some faint several times in a few days, while the causes of syncope are relatively complex and the diagnosis requires a series of assessment processes. In order to better prevent and reduce the harm that syncope brings to daily life. It is necessary for the public to know and understand syncope!
1. What is syncope? How does syncope occur?
Syncope is a symptom or a syndrome that results in a sudden, transient, self-limiting loss of consciousness due to various causes of widespread cerebral insufficiency of blood supply to the brain, resulting in a high degree of cortical depression, causing the patient to faint. Syncope generally resolves itself rapidly and returns to normal within a short period of time. The average time frame for syncope is 12 seconds (5-22 seconds). A normal adult brain blood flow is 50-60ml/100g brain tissue/min, when the cerebral blood flow decreases to 30ml/100g brain tissue/min or less, syncope occurs, because this insufficient blood supply is transient, so the patient can generally quickly return to normal within a short period of time, but the harm caused by syncope can not be ignored!
2, we often hear about dizziness, vertigo, so syncope and dizziness, vertigo is the same thing?
To clarify syncope, we must first clarify the difference between syncope and dizziness, vertigo, and coma.
”Dizziness” is the least severe symptom. Dizziness can be a symptom that accompanies many diseases or can exist as a separate symptom. It is a feeling of dizziness, or what some people describe as “light-headedness” or “light-headedness”. If the dizziness is accompanied by “spinning”, feeling that everything around you is spinning, or floating up and down, or swinging from side to side, then it is vertigo. Although the symptoms of dizziness and vertigo are severe, the person is conscious and does not lose consciousness.
Syncope is also commonly referred to as fainting and unconsciousness. The difference between them is that there is loss of consciousness in syncope, which is called “unconsciousness”, while the “dizzy” consciousness of dizziness and vertigo is awake. So when you have syncope, you must not be careless and go to the hospital in time.
Coma, on the other hand, is a disorder of consciousness caused by various reasons, and strong painful stimuli do not make the patient awake, and this disorder of consciousness lasts for a long time and requires active treatment of the original disease before the symptoms can be relieved. Coma is mostly seen in lesions of brain tissue, which is a more serious disease.
3.What are the usual clinical manifestations of syncope?
First of all, the time of syncope is relatively short, usually not more than 20 seconds, there will be a rapid loss of consciousness, and can be self-relieved, when the attack can not stand, a state of dystonia of the limbs, can appear without some preliminary aura and sudden loss of consciousness, can also appear dizziness, pale, general weakness, nausea, cold sweat and other aura, some may occasionally appear a brief general Twitching, or some other symptoms, such as panic, flushing or some other symptoms before syncope, while no symptoms are usually left behind after the return of consciousness from syncope, occasionally dizziness or drowsiness, bowel movements, or even incontinence. Sometimes retrograde amnesia can occur, mostly in elderly patients. Sometimes there can be obvious weakness and other manifestations after recovery from syncope.
4. What are the common causes of syncope?
We say that syncope is a symptom or a syndrome, and there are five main categories of common causes of syncope.
One category is neurally mediated syncope, including ① vasovagal syncope ② carotid sinus syncope ③ situational syncope such as coughing, sneezing, gastrointestinal stimulation, urination, after exercise, after a full meal, etc.
The second category is upright hypotensive syncope, such as autonomic dysregulation, postural hypotension caused by multi-system atrophy, ③ syncope caused by drugs, blood volume deficiency, etc.
The third category is arrhythmogenic syncope
The fourth category is syncope caused by organic heart disease or cardiopulmonary disorders, including acute myocardial infarction, cardiomyopathy, mucus aneurysm, aortic coarctation, cardiac compression, pulmonary embolism, etc.
The fifth category is cerebrovascular syncope, including stroke, brain tumor, vascular steal syndrome, etc.
So the causes of syncope are very complex.
5, since the causes of syncope are so complex, what tests are needed for patients who experience syncope?
The causes of syncope are complex, and sometimes the diagnosis is difficult, and some of them are not clear even after a series of examinations, which accounts for about 20%. To clarify the cause of syncope, the first step is to ask detailed questions about the onset and course of the syncope, i.e., medical history, which is a very important step to clarify the cause of syncope. Secondly, more auxiliary tests may have to be performed. Generally, all patients with syncope are first examined for cardiac causes, including routine electrocardiogram, and those who cannot find abnormalities on routine electrocardiogram should undergo ambulatory electrocardiogram (Holter) and echocardiogram to understand the cardiac condition. If arrhythmias are suspected and Holter is not positive, invasive electrophysiological examinations may be performed if necessary. Plant nerve function tests may be performed if abnormalities of plant nerve function are suspected. If organic neurological disease is suspected, EEG, cranial CT or MRI should be done to rule out epilepsy and to clarify the nature of central nervous system disease. Arterial blood gas and glucose measurement should be done for suspected pulmonary insufficiency and hypoglycemia. Suspected vasovagal syncope requires an upright tilt test. Therefore, patients with syncope may have to go to multiple departments for examination, such as neurology to check whether syncope is caused by brain disorders, and cardiovascular department to check whether syncope is caused by cardiac reasons, and we recommend that most patients with syncope should go to neurology and cardiology for major investigations.
6. What are the risks for patients who experience syncope?
First of all, it is clear that studies have shown that patients with various syncope have 1.31 times higher risk of death, 1.27 times higher risk of myocardial infarction or coronary heart disease, and 1.06 times higher risk of stroke than those with non-syncope. However, there is no need to worry too much. For young (<45< span="">years old) syncope patients with normal ECG and no heart disease, they mostly have neurally mediated syncope and unexplained syncope, and studies have shown that their risk of death does not increase, so for patients with syncope, it is crucial to find out the cause promptly, especially for middle-aged and elderly patients who have syncope. Therefore, it is crucial to find out the cause of syncope in a timely manner, especially in middle-aged and elderly patients who experience syncope, so as to reduce the risk of disability and death.
7.How is syncope treated and what treatment measures are available?
Syncope is a more complex syndrome, it can have more serious heart disease, more serious brain disease, or less serious, such as urination reflex, cough reflex caused by syncopal episodes, these factors cause syncope is relatively complex, some need treatment, some do not need treatment, only with some lifestyle changes to avoid syncopal episodes, so the treatment of syncope, the premise The reason for the syncope is to find the cause of the syncope, and then to carry out different treatment measures for different causes, is the heart, to carry out cardiac drugs or surgery, is the brain to carry out brain drugs or surgery to avoid syncope attacks, is reflex syncope we only need lifestyle changes, such as emotional changes occurring syncope need to regulate our emotions, mentality, appropriate exercise, participate in some social activities and other lifestyle changes. For example, urinary syncope should be educated not to hold urine, male patients to sit or squat to urinate; postural hypotension caused by us lying down to get up as slowly as possible, first lie down, then slowly get up, do not stand up all at once, these can be avoided through lifestyle changes to avoid syncope.
8, as a general public, what to do in daily life when encountering patients with syncope?
First of all, we should not panic to avoid further injury, secondly, we should keep the patient’s respiratory tract open, and in case of vomiting, the patient’s head should be tilted to the side to prevent suffocation, thirdly, because most syncope patients can relieve themselves, so the patient should be kept lying down with the feet slightly elevated, the head lowered, and the collar loosened if the collar is tight to ensure the blood supply to the brain; at the same time, pay attention to keeping warm, and before consciousness is restored, no drinks or medication should be given. The fourth is to go to the hospital in time to clarify the cause, and the fifth is that if the patient cannot wake up in a short time (usually less than 1 minute), it may be necessary for a professional to determine whether the loss of consciousness is caused by syncope or something else to avoid danger.
9. Can syncope be prevented? What are the specific measures
We say that there are two types of syncope, one is a slow-onset seizure with an aura, and the other is a sudden seizure without an aura.
For syncope with aura we can often take some preventive measures to avoid the occurrence of syncope or fall accidental injury, first of all, avoid some triggers of syncope, such as excessive mental tension and excitement caused by fright, terror, etc.; prolonged bed rest or squatting for a long time suddenly rise, so that the blood pressure drops significantly; sprint after strenuous exercise suddenly stand still, etc. ② Find the causes of syncope and prevent them, such as the aforementioned cardiac causes of heart panic when sitting down in time to rest, urinary syncope to avoid standing to urinate, cough syncope to avoid forceful and violent coughing, etc. may avoid the occurrence of syncope, ③ There is also a situation that a considerable number of patients with syncope often have dizziness, pale face, general weakness, nausea, cold sweat, and a decrease in blood pressure and pulse rate before syncope. Blood pressure drops, pulse rate increases and other aura, at this time, if timely lying down, can avoid syncope, but also to prevent trauma caused by falls.