Introduction
Syncope is the medical terminology used for passing out. In simple terms, it means to faint. It is a common condition. Syncope occurs due to the short-term sinking of the blood that passes to the brain. This condition can also happen if there is a sudden drop in blood pressure. Recovery is voluntary, and confusion is a common trait experienced post-syncope. Another reason for syncope may be an underlying dysfunction in the ANS. ANS, or the autonomic nervous system, is in control of multiple functions of the body that take place without notice, such as breathing, heart rate, and urinary bladder control.
What Is Cardiac Syncope?
Syncope affects approximately 40 percent of the population. It is a phenomenon that leads to the sudden and abrupt loss of consciousness along with an imbalance of postural tone. Syncope is of different types, and it can be categorized into cardiac syncope, orthostatic syncope, and neurally-mediated syncope. Cardiac syncope is when the sole reason for fainting is related to the cardiovascular system, for the most part, the heart, and the heart’s vasculature. Cardiac syncope accounts for a small percentage of all syncope, approximately 10 percent. Cardiac syncope is relatively life-threatening and demands deep investigation into its causes in addition to immediate treatment. They are potentially fatal, with a mortality rate of roughly 30 percent.
What Are the Types of Cardiac Syncope?
There are different types of syncope. They are:
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Vasovagal Syncope or Neurocardiogenic Syncope - It is a common type of syncope caused by stress or strain that decreases the blood pressure and heart rate.
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Postural or Orthostatic Syncope - Syncope happens when there is a sudden change of posture.
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Cardiac Syncope - It happens when there is a sudden drop in blood pressure.
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Neurologic Syncope - It can happen in neurological conditions such as seizure, stroke, or transient ischemia.
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Postural Orthostatic Tachycardia Syndrome - Increased heart rate when changing the posture immediately.
What Causes Cardiac Syncope?
Syncope is caused by a temporary overall failure of cerebral microcirculation. The heart ceases to give rise to adequate cardiac output to give out fresh oxygenated blood to the brain, and this causes a cardiac syncope. Most often, cardiac syncope is due to arrhythmia. An arrhythmia occurs when the heart’s electrical system is malfunctioning and thus is producing an abnormally fast or unusually slow heart rate.
Another reason for a cardiac syncope can be an obstructive pathology within the heart or, in simple terms, an obstruction present in the heart’s structure. Some examples of these are tumors, aortic stenosis, myocardial infarction, or congenital hypertrophy. These obstructions lead to valve rupture and cardiac tissue damage.
It should be noted that cardiovascular diseases are the second most common cause of syncope, with arrhythmias being far more common than obstruction diseases. Also, obstruction diseases are more generally found in patients with comorbidities like diabetes, hypertension, obesity, and in chain smokers.
What Are the Clinical Signs and Symptoms of Cardiac Syncope?
The cornerstones for evaluating cardiac syncope are the patient’s medical history and physical examination. History of syncopal episodes, underlying medical abnormalities, comorbidities, and cardiovascular medications are all valuable assets. A keen eye for the patient’s hydration status, symptoms such as confusion and hyperventilation before syncope, and the patient's status after regaining consciousness should be maintained.
It is always helpful if the patient informs the healthcare provider beforehand regarding their history of syncope. A thorough physical examination that includes blood pressure checks on arms, as well as legs and heart rate, is vital in both supine and standing positions. The classical signs include sudden headache, feeling dizzy, confusion, blacking out, imbalance, having tunnel vision, palpitations, and feeling lightheaded.
All of the above are called premonitory symptoms. Syncope can be a warning sign for more severe conditions, so it is always wise to schedule an appointment with a doctor after an episode of syncope.
Mentioned below are a few of the signs and symptoms of cardiac syncope.
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Restlessness.
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Sweating.
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Vomiting.
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Headache.
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Dizziness.
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Difficulty to comprehend.
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Verbal incompetency.
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The ringing of the ears.
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Loss of balance.
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Heavy breathing.
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Confusion.
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Altered state of mind.
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Tunnel vision.
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Loss of consciousness.
How Can Syncope Be Managed?
The management of syncope starts with careful diagnosis and evaluation of the condition. The doctor may ask a series of related questions and may also make one go through specific necessary tests. These tests evaluate the state of the heart and its functioning. Particular blood work to rule out underlying conditions such as anemia may also be conducted. Other tests include an electrocardiogram (ECG), a TMT-treadmill test, and tests to check the working of the autonomic nervous system, such as autonomic reflex tests. Based on the results of these tests and many more, changes in diet, medications, and lifestyle are advised. Syncope management aims to reduce recurrence and mortality rates and is directed at correcting underlying causes, especially advanced cardiac illness.
Cardiovascular syncope or cardiac syncope requires immediate attention because it can be one of the signs of an underlying cardiovascular disease. Early prevention and diagnosis are key factors to prevent cardiac syncope. The patient must visit the healthcare provider at the first sign of any of the symptoms of cardiac syncope. Maintaining a healthy balance between diet and physical activity by consuming fruits and vegetables, doing regular exercise, and living a life full of activeness are a few of the preventive measures for cardiac syncope.
How to Prevent Syncope?
To help prevent syncope (fainting),
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Stay hydrated.
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Avoid prolonged standing.
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Taking breaks if feeling lightheaded.
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Be cautious when changing positions quickly.
How to Help a Syncope Patient?
The difference between a thought and a decision is the immediate action taken.
Bearing this in mind, look out for the obvious signs, including blue lips, pale skin, difficulty breathing, confused behavior, and chest pain. Make sure to lay the patient flat and elevate their legs to restore blood flow into the brain. If the patient is wearing tight-fitting clothes, loosen them to reduce suffocation and make way for smooth blood circulation throughout. Try reviving the patient from unconsciousness by yelling their name or tapping them briskly. If the patient gains consciousness, give them sweet fluids like cold orange juice. In rare cases, if there is bleeding or vomiting, tilt the patient to one side and immediately call for an ambulance.
Conclusion
Syncope is a common condition that affects all age groups. Cardiac syncope is presented generally in older patients and is relatively rare amongst the younger population. Primary healthcare providers usually identify cardiac syncope. The diagnosis of cardiac syncope must be aligned with a medical history and appropriate diagnostic tools. Simple on-spot management includes raising the legs while in a prone position, sitting down while feeling dizzy, and keeping oneself hydrated throughout the day.