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syncope(sing'ko-pe, sin') [Gr. synkope, fainting]
The most frequent causes of syncope are vasovagal (the common fainting spell), cardiogenic (esp. arrhythmogenic, valvular, or ischemic), orthostatic (such as due to dehydration or hemorrhage), and neurogenic, e.g., due to seizures. Many medications (such as sedatives, tranquilizers, excessive doses of insulin), food allergies, hypoglycemia, hyperventilation, massive pulmonary embolism, aortic dissection, atrial myxoma, carotid sinus hypersensitivity, coughing, urination, and psychiatric disease can also result in loss of consciousness.
The patient typically complains of having suffered a sudden and unexpected fall to the ground, with loss of awareness, and then rapid recovery of orientation. Lacerations, abrasions, or other injuries occasionally result from the fall.
The history may contain useful clues. For example, if the patient stood up just before losing consciousness, an orthostatic cause is likely; if a patient is confused or disoriented for a long time after losing consciousness, seizures are probable; if a young patient passes out while at a wedding or other stressful event, vasovagal syncope is likely. The diabetic patient who becomes agitated and sweaty before passing out should be rapidly assessed and treated for low blood sugar.
The examination of the patient may reveal the cause; e.g., a loud aortic murmur may point to valvular heart disease, and a pale patient with orthostatic vital signs may be dehydrated or bleeding. Electrocardiographic monitoring after the event may reveal arrhythmias or evidence of ischemia. Depending on clinical circumstances, further evaluation may include carotid sinus massage, 24-hour ambulatory monitoring, month-long event monitoring, implantable loop monitoring, tilt-table testing, echocardiography, or psychiatric evaluation. In most cases, despite thorough evaluation, a precise diagnosis is not determined.
Any person with sudden loss of consciousness should be placed in a supine position, preferably with the head low to facilitate blood flow to the brain. At the same time, a clear airway should be ensured. Clothing must be loosened, esp. if the collar is tight.
Fainting (one form of syncope) is usually of short duration and is counteracted by placing the person supine. If recovery from fainting is not prompt and complete, a prompt assessment of airway, breathing, circulation, and cardiac rhythm is needed; assistance should be obtained and the person transported to a hospital. A person who refuses hospital evaluation after recovering from a fainting episode should be encouraged to be examined by a physician as soon as possible.
carotid sinus syncope
neurocardiogenic syncopeVasodepressor syncope.
shallow water syncope
The patient, who may have just experienced a stressful or emotionally upsetting event, reports a feeling of wooziness, nausea, and weakness, followed often by a feeling that darkness is closing in on him. A ringing in the ears may follow, along with inability to maintain an erect posture. Witnesses may report profuse sweating or a loss of color in the face. During the event, an unusually slow pulse may be present. Several convulsive movements of the body may be noted if blood flow to the brain is inadequate but the loss of consciousness is not accompanied by other signs of seizures, e.g., tongue biting, incontinence, or a prolonged postictal period of confusion.
Placing the patient in a sitting position with the head lowered between the legs or in a horizontal or Trendelenburg position restores blood flow to the brain and promptly aborts the attack. A brief examination should be performed to make sure the affected person can move all extremities and facial muscles and can speak clearly and understand speech. The carotid arteries should be checked for bruits, and the heart for evidence of arrhythmia or heart murmurs. Blood pressure, pulse, and oxygenation, as well as cardiac rhythm, should be monitored. Fluids should be administered by mouth if nausea has resolved, or by vein if the patient cannot take liquids orally and has an intravenous access in place. An electrocardiogram should be obtained or cardiac monitoring ordered if the patient has a history of cardiac disease, is elderly, or has multiple risk factors for cardiac disease or dysrhythmias. A complete blood count, serum electrolytes, blood urea nitrogen, creatinine, and glucose should be checked. Before the patient is allowed to get up again, vital signs should be checked; if they are normal, the patient should be assisted first to a sitting position and then to a standing position before walking independently. Patients who faint may need specialized follow-up examination, e.g., with a cardiologist, internist, or neurologist.
vasovagal syncopeVasodepressor syncope.
Patient discussion about syncopal
Q. i am 12 and my hair is falling out what do i do? there is like a hair ball in my tub
Q. I found out 1week ago i was 6wks pregnant and lastnight i passed a 1/2dollar size clear ball did i miscarrie? the ball was clear,soft and jellie like and it came w/a lot of blood but i didnt see no signs of a baby or anything like that