Syncope is the sudden loss of consciousness, with immediate and spontaneous recovery usually within seconds, sometimes minutes. People may describe syncope in a wide variety of ways, such as: fainting, blacking out, falling out, having a spell, or losing consciousness.
If loss of consciousness is prolonged, or requires Electrical Cardioversion, it is not syncope anymore. It can be seizure or other more serious cause.
The main mechanism of syncope is decreased cerebral perfusion. The brain needs a constant supply of glucose, (through adequate cerebral blood flow) to function, and any interruption to this, even for few seconds can lead to loss of consciousness or syncope.
Syncope is a symptom of an underlying disease process, rather than a disease itself.
Although syncope mimics a death-like experience, eliciting extreme consternation among both patients and their families, most syncopal events have a benign cause.
Broadly, causes of syncope can be divided in Three categories:
Reflex Syncope, Syncope because of heart problems and syncope related to Blood vessel problems.
Almost 90 % of syncope are Reflex and blood vessel related syncope and are more benign.
Here are most common causes of Syncope:
Vasovagal Syncope, it is the most common type of syncope and represents reflex syncope.
Vasovagal Syncope has precipitating events, such as fear, severe pain, emotional distress, instrumentation or prolonged standing. And it is associated with typical prodromal symptoms. These consist of light-headedness, confusion, pallor, nausea, salivation, sweating or other symptoms.
Treatment: Conservative measure includes avoiding situations or stimuli, that have caused them, Tilt training and increasing use of salt and fluid.
Drug therapy with beta-blockers, SSRIs, hydrofludrocortisone, proamatine, might be useful if conservative measures fail.
Situational Syncope, it is also reflex syncope.
Situational syncope is diagnosed if syncope occurs during or immediately after urination, defecation, cough or swallowing.
Situational syncope is usually benign. simple strategies are used for treatment such as increasing hydration, intaking more salt. Amn improving awareness of warning symptoms. and taking early evasive action.for example getting down. Seat or lying position.
Another common cause of syncope is Orthostatic syncope.
It is syncope, in which the upright position causes arterial hypotension and decreased cerebral perfusion. It happens, When person changes position, from sitting or lying to an upright position.
It is more common among elderly.
Orthostatic syncope is diagnosed when, when there is documentation of orthostatic hypotension. (defined as a decrease in systolic blood pressure more then 20 mm Hg or a decrease of systolic blood pressure to less then90 mm Hg) associated with syncope or presyncope.
Treatment:
Rising slowly from supine and sitting position, a gradual change in posture.
Avoiding medications that can cause orthostatic hypotension (diuretics, vasodilators).
Use of compression stocking to improve venous return.
Other causes of syncopes are less common but more serious.
Such as heart and blood vessel caused syncope.
Heart related causes may include an abnormal heart rhythm, problems with the heart valves or heart muscle and blockages of blood vessels from a pulmonary embolism or aortic dissection among others.
Generally, Treatment of underlying cause is the focus of treatment in any type syncope.
But, During an acute episode, patients should be made to sit or lay down quickly and raising the legs help recovery in patients with reflex postural hypotension event. Placing patients in a horizontal position after the acute event and preventing rising too soon.
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