Syncope: Causes, Work-ups & Managements
Syncope can be defined as loss of consciousness and muscle strength for a short time. Syncope features fast onset, short duration, spontaneous recovery. In most cases syncope is caused by a temporary decrease in blood flow to the brain due to low blood pressure. Loss of consciousness (LOC) may precede pre-existing symptoms, such as lightheadedness, sweating, pale skin, blurred vision, nausea, and vomiting.
Syncope causes are cardiogenic, neurocardiogenic, and orthostatic hypotension. Among these, neurocardiogenic is the most common, and vasovagal syncope is the most common among young people. This occurs when vasodilation or an inappropriate decrease in heart rate occurs. It can also occur when the carotid sinus is under pressure. Cardiac syncope is the most serious condition requiring treatment. In this case, there is abnormal heart rhythm, heart valves or heart muscle, pulmonary embolism or aortic dissection. Syncope due to orthostatic hypotension is caused by a sudden decrease in blood pressure when sitting and suddenly occurs. Or drug-induced, volume depression, or autonomic nervous system problems. Now let's look at a little more about syncope and how to diagnose and treat it.
Work-ups
First, let's look at the basic but important tests, the three position blood pressure test and the head up tilt test. Three position blood pressure test is simply to measure blood pressure in three postures of supine, sitting, standing (immediately). If this happens suddenly in the standing blood pressure, the syncope due to orthostatic hypotension can be suspected. Head-up tilt test is a test to confirm syncope. It should be stopped and fasted. Attach the EKG and blood pressure monitor and set the angle of the examination table at 70 degrees. It monitors the EKG and blood pressure and checks when syncope occurs.
Causes
The most common is the vasovagal syncope. If the blood flow to the brain decreases as the heart rate and blood pressure sharply decline, you will temporarily lose consciousness. This phenomenon is due to abnormal responses to the nervous system that regulates heart rate and blood pressure by various triggers, such as stress or excessive tension. EKG, echocardiography, 24hour holter test, CPX, blood test, and MRI can be performed for diagnosis. Vasovagal syncope is usually recovered by itself and does not require special treatment. However, it may be a symptom of a particular disease, or it may be a side effect of the medication being taken.
Cardiac syncope is in most cases a serious condition requiring correct treatment of the cause. Many cases occur because of a decrease in cerebral blood flow due to arrhythmia. EKG, echocardiography, 24hour holter test, CPX, blood test, and MRI can be performed for diagnosis. Therapeutic drugs for Arrhythmia include Na + channel blockers, K + channel blockers, Ca2 + channel blockers, and β-blockers.
Syncope due to orthostatic hypotension has low blood pressure and fainting due to impaired blood pressure control when standing up. In the case of a normal person, the sudden decrease in venous return leads to a sudden decrease in cardiac output, resulting in a decrease in blood pressure. In this case, systolic is reduced by about 5-10 mmHg and diastolic is increased by about 5-10 mmHg. However, orthostatic hypotension is characterized by a large variation in blood pressure with changes in posture. The definition of orthostatic hypotension implies a systolic drop of more than 20 mmHg or a diastolic drop of more than 10 mmHg when compared to the resting blood pressure measured in the lying state. The blood pressure should be measured within 3 minutes after standing. The causes of orthostatic hypotension are autonomic failure, volume depletion, drug induced, and reflex syncope.
Syncope causes are cardiogenic, neurocardiogenic, and orthostatic hypotension. Among these, neurocardiogenic is the most common, and vasovagal syncope is the most common among young people. This occurs when vasodilation or an inappropriate decrease in heart rate occurs. It can also occur when the carotid sinus is under pressure. Cardiac syncope is the most serious condition requiring treatment. In this case, there is abnormal heart rhythm, heart valves or heart muscle, pulmonary embolism or aortic dissection. Syncope due to orthostatic hypotension is caused by a sudden decrease in blood pressure when sitting and suddenly occurs. Or drug-induced, volume depression, or autonomic nervous system problems. Now let's look at a little more about syncope and how to diagnose and treat it.
Work-ups
First, let's look at the basic but important tests, the three position blood pressure test and the head up tilt test. Three position blood pressure test is simply to measure blood pressure in three postures of supine, sitting, standing (immediately). If this happens suddenly in the standing blood pressure, the syncope due to orthostatic hypotension can be suspected. Head-up tilt test is a test to confirm syncope. It should be stopped and fasted. Attach the EKG and blood pressure monitor and set the angle of the examination table at 70 degrees. It monitors the EKG and blood pressure and checks when syncope occurs.
Causes
The most common is the vasovagal syncope. If the blood flow to the brain decreases as the heart rate and blood pressure sharply decline, you will temporarily lose consciousness. This phenomenon is due to abnormal responses to the nervous system that regulates heart rate and blood pressure by various triggers, such as stress or excessive tension. EKG, echocardiography, 24hour holter test, CPX, blood test, and MRI can be performed for diagnosis. Vasovagal syncope is usually recovered by itself and does not require special treatment. However, it may be a symptom of a particular disease, or it may be a side effect of the medication being taken.
Cardiac syncope is in most cases a serious condition requiring correct treatment of the cause. Many cases occur because of a decrease in cerebral blood flow due to arrhythmia. EKG, echocardiography, 24hour holter test, CPX, blood test, and MRI can be performed for diagnosis. Therapeutic drugs for Arrhythmia include Na + channel blockers, K + channel blockers, Ca2 + channel blockers, and β-blockers.
Syncope due to orthostatic hypotension has low blood pressure and fainting due to impaired blood pressure control when standing up. In the case of a normal person, the sudden decrease in venous return leads to a sudden decrease in cardiac output, resulting in a decrease in blood pressure. In this case, systolic is reduced by about 5-10 mmHg and diastolic is increased by about 5-10 mmHg. However, orthostatic hypotension is characterized by a large variation in blood pressure with changes in posture. The definition of orthostatic hypotension implies a systolic drop of more than 20 mmHg or a diastolic drop of more than 10 mmHg when compared to the resting blood pressure measured in the lying state. The blood pressure should be measured within 3 minutes after standing. The causes of orthostatic hypotension are autonomic failure, volume depletion, drug induced, and reflex syncope.
