Unlocking Syncope: Causes & Solutions

Syncope and faintness are interchangeably used in clinical practice and they donate the same pathophysiological mechanism of their production. The difference between faintness and syncope is often quantitative. Syncope refers to generalised weakness of muscles, loss of postural tone, inability to maintain erect posture and loss of consciousness. While faintness implies only a lack of strength and a sense of impending loss of consciousness.​​In this comprehensive blog, we will delve into the world of fainting episodes and cope with this sudden loss of consciousness.

Exploring underlying factors 

Usually patients have warning signs in the form of a sense of giddiness, movements of surrounding objects or may have the sensation of feeling something wrong with the body. It results from sudden impairment of cerebral blood flow due to fall in blood pressure due to any cause. Common causes of it include : 

• Irregular heart beat
• Extreme stress 
• Dehydration
• Vomiting 
• Extreme pain or fear
• Low blood pressure
• Pregnancy

Recognising Symptoms Of Syncope

Before fainting, following symptoms can take place : 

• Sweating
• Occasional vomiting 
• Nausea
• Dizziness
• Change in breathing such as breathing faster or deeply 
• Blurred vision
• Blacking out
• Feeling weak when standing
• Headaches
• Drop in blood pressure
• Weakness

Understanding The Variations

Vasovagal Syncope 

This is a common type of syncope. Vasovagal syncope occurs when the part of your nervous system that regulates heart rate and blood pressure malfunctions. Can be seen in normal persons. It tends to occur during emotional stress., after an injury or an accident or during severe pain. Mild blood loss, prolonged bed rest, organic heart disease and prolonged fasting act as precipitating factors in susceptible individuals. Some common symptoms of it are : 

• Nausea
• Pale skin
• Feeling warm
• Blurred vision
• Sweats

There are few factors which lead to trigger vasovagal syncope such as Seeing blood, Heavy blood drawn, heat exposure and fear of bodily injury. 

Micturition Syncope 

This is seen in elderly or after urination particularly after arising from the sitting position. It has been suggested that release of intravesical pressure during micturition causes sudden vasodilation which gets augmented by standing leading to syncope. Common symptoms include : 

• Dizziness
• Loss of consciousness, when passing urine.
• Drowsiness
• Dehydration
• Hot weather 

Seek medical help immediately if a patient has pain in chest or lower back, a severe headache, irregular heartbeat, difficulty breathing and double vision. 

Cardiac Syncope 

Sudden reduction on cardiac output causes cardiac syncope. It results from both abnormal decreases in heart rate that AV blocks in heart rate and ventricular tachycardia takes place. Common symptoms include : 

• Dizziness
• Nausea
• Change in vision
• Lightheadedness

Carotid Sinus Syncope 

This occurs due to two mechanisms : 

• There is vagal mediated cardiac slowing.
• There is a fall in blood pressure due to depressor response. 

Normally, the carotid sinus is sensitive to stretch, hence, fainting can be induced in sensitive patients either by turning the head to one side or by tight fitting cervical collar. 

Cough Syncope 

This occurs in males with chronic bronchitis. After vigorous coughing, the patient suddenly becomes weak and loses consciousness momentarily. This generally occurs due to decreased venous return to the heart by rise in intrathoracic pressure during coughing.  Common symptoms include : 

• Dizziness
• Coughing
• Change on vision

Diagnostic Pathways

A syncope specialist will do a physical exam and a careful review of the medical history of a patient. Then a patient have one or more tests to help determine the cause of your syncope.Common investigations include : 

• Measurement of serum electrolytes, glucose and haematocrit.
• Blood and urine screens.
• Exercise stress test
• Tilt table testing
• Autonomic reflex testing 
• Electrophysiological cardiac testing
• MRI 
• ECG

Management and prevention

The major aim of treatment is to avoid fall or injury during an attack.Syncope is benign in most of the cases and does not require any treatment. Patients seen during the early phase of syncope should be placed in a position which allows maximum cerebral blood flow that is head is lowered between knees if sitting or patient should lie in supine position.

All the clothes should be loosened and the head is turned to one side to avoid fall of tongue back into the throat. Nothing should be given orally till the patient regains consciousness. Other treatment options include : 

• Taking prescribed medication
• Being extra cautious when in standing position.
• Biofeedback training to control a fast heartbeat.
• Getting treatment for structural heart disease.
• Avoiding known triggers. 

Conclusion 

Patient education is more important in patients with syncope. As we conclude our exploration of fainting episodes, it becomes evident that knowledge and awareness are powerful tools in managing this condition and individuals can empower themselves to take control of their health and well-being.