Syncope. What is it in the adult as often occurs, symptoms, causes, treatment

Syncope (syncope) - is faint. Transient loss of consciousness provoked sharp disruptions in the cardiovascular system. The brain does not have enough blood, breathing difficult, muscle tone falls to zero and the man falls to the ground.

What is syncope in adults?

According to statistics, half of the adult population once experienced syncope. To the doctor to address only 3.5%. The occasion of the visit to the clinic become more injuries in the fall. 3% emergency surgery patients complained of recurrent seizures. Special studies have discovered that 60% of adult subjects undiagnosed syncope.

Fainting can occur in young persons of both sexes aged 17-32 years. Any healthy person in extreme conditions it can fall unconscious as the physiological possibilities have a limit to adapt.

Classification of syncope, the code in ICD 10

Syncope, what it is and on what types of shares, determined the European Community of Cardiology.

View syncope	internal rejection	procatarxis
reflex	drop in blood pressure, bradycardia, impaired cerebral microcirculation	bing, severe pain, emotional outburst, cough, rapid rotation of the head, crushing the collar
Orthostatic hypotension (orthostatic hypotension)	life-threatening conditions - a sharp drop in pressure in the arteries and veins, depression metabolism, inhibition of cardiac reactions, blood vessels, nervous system for a long distance or a quick change body position	long stay on his feet in the debilitating conditions (heat, crowded cargo hold), posture change from horizontal to vertical, taking certain drugs, Parkinson's disease, cerebral degeneration cell
cardiac (arrhythmia)	insufficient release of blood due to atrial flutter and atrial fibrillation, ventricular tachycardia, a complete transverse blockade	heart disease
cardiopulmonary	a mismatch between the needs of the body's circulatory and heart capacity	narrowing of the pulmonary artery, the pressure increase in the bloodstream from the heart to the lungs, benign tumor in the heart (myxoma)
cerebrovascular	changes in cerebral vessels leading to inadequate blood supply to the brain tissues and the defeat of his	deficiency of basilar krovopriliva (in the brain) and vertebral arteries steal syndrome (ischemia from a sharp lack of blood in the organ)

The ICD-10 fainted and collapse R55 combined code.

the state of development stage

Physicians faintness separated into 3 stages:

1. Prodromal with aura;
2. Loss of consciousness and sustainability (fall);
3. Postsinkopalnoe state.

The causes of syncope

In clinical studies, cardiologists, neurologists and other specialists were not able to determine the true cause of syncope and its recurrence in 26% of subjects. A similar picture emerges in practice, which makes it difficult treatment choices.

This is due to episodic precedents, and the variety of triggers:

• heart disease, blood vessels;
• acute short-term reduction in blood flow to the brain;
• increased excitability of the vagus nerve, which controls the muscles of respiration, speech, heart, digestive system;
• heart arrhythmia;
• lowering glucose levels in the bloodstream;
• glossopharyngeal nerve lesion;
• infectious diseases;
• psychical deviations;
• hysterical fits;
• head trauma;
• fatigue;
• hunger.

This is just part of a long list of possible causes of syncope.

vasodepressor syncope

Syncope, what it is in simple language: vaso - a blood vessel, a depressant - nerve, reduces the pressure. The term vasodepressor similar vasovagal, where the second part of the word specifies that the vagus nerve. He goes from the skull to the intestine and can suddenly redistribute intestinal blood flow in vessels, impoverishing the brain.

This occurs on a background of emotional pain or peak meal, prolonged standing or lying down, fatigue of noisy crowded.

Prodromal symptoms may be weakness, cramping abdominal pain, nausea. They last up to 30 minutes. During transient loss of consciousness is sharply reduced postural muscle tone, body supports a certain position in space.

Risk factors for addiction to vasodepressor (vasovagal) states:

• dosage blood loss, such as donors;
• low hemoglobin;
• total hyperthermia (fever);
• heart diseases.

orthostatic state

Hypotension in direct (o) the ability to develop a fixed position from mild weakness to severe collapse, when a man's life hangs in the balance.

When lifting from the bed, exhausting standing prodromal symptoms are:

• rapid increase in muscle weakness;
• misting of sight;
• dizziness to loss of coordination, a sense of falling through the legs and body;
• sweat, chilliness;
• nausea;
• a sense of melancholy;
• sometimes heart palpitations.

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The average degree of hypotension is recognized by:

• wet cold extremities, face, neck;
• strengthening pallor;
• turn off for a few seconds, urinate;
• weak, slow pulse.

Heaviness, longer collapse is accompanied by:

• shallow breathing;
• unconscious urination;
• convulsions;
• cyanotic pallor with red and blue "marble" veins on the cold cover.

If the first 2 cases, a person has time to sit down, lean, when severe, he immediately falls and is injured.

Causes of orthostatic condition:

• neuropathy;
• Bradbury-Eggleston syndrome, Shy-Drager, Riley-Day, Parkinson.
• diuretics, nitrates, antidepressants, barbiturates, calcium antagonists;
• severe varicose veins;
• infarction, cardiomyopathy, congestive heart failure;
• infection;
• anemia;
• dehydration;
• adrenal tumor;
• overeating;
• tight clothing.

hyperventilation

Syncope, it is uncontrolled quickening and deepening of breathing:

• It occurs during anxiety, fear, panic;
• second momentum fainting preceded by a decrease in heart rate from 60 to 30-20 beats per minute, heat in the head, arrhythmia;
• It develops on the background of hypoglycemia, pain peaks.

2 variant isolated hyperventilation syncope - hypocapnic (lowering of blood carbon dioxide) and vasodepressor.

carotid sinus syncope

Carotid sinus - reflexogenic zone before the place where the carotid artery diverges at the inner and outer channel. Since sinus blood pressure monitors, it leads to hypersensitivity heart dysfunctions, peripheral tone, brain blood vessels, which is able to turn into a syncope.

Syncope of this nature are found in men over the second half of life and are associated with irritation karotidnosinusnoy area deviation of the head backwards when trimming, shaving, placing objects object over his head; squeezing collar, tie, tumor formation.

Prodromal symptoms is missing or appears briefly tightness in the throat and chest, shortness of breath, pain. Seizure duration 1 min. can be convulsions. After the patients sometimes complain of psychological oppression.

cough syncope

Syncope when coughing can experience the men for 40 years, mostly heavy smokers, choking cough. At risk are hard coughing, broad-chested, with signs of obesity lovers eat, take alcohol.

Fainting may be provoked bronchitis, asthma, laryngitis, whooping cough, pulmonary emphysema (pathological swelling), cardio-pulmonary diseases that cause hacking cough until blue in the face and swelling veins on the neck. Syncope lasts from 2 to 3 minutes. The patient is perspiring, his face fills cyanosis, sometimes the body twitches.

swallowing

What is the mechanism of syncope swallowing type it remains a mystery. Perhaps this excessive stimulation of the vagus nerve movements of the larynx, to respond to the work of the heart, or the increased sensitivity of the brain and cardiovascular structures to the impact of valgus.

By provoking factors include diseases of the esophagus, throat, heart, lungs; tensile tissue irritation during bronchoscopy (probe trial), tracheal intubation (introduction of the tubular expander to restore breathing).

Swallowing syncope occur either within the gastro-intestinal pathologies, or in the case of accession of heart disease (angina, heart attack), the treatment of which is used digitalis preparations. But also occur in healthy people.

Nikturicheskie fainting

Syncope when urinating and during defecation, are more common for men over 40 years. Brief loss of consciousness, sometimes with convulsions, it is possible, after going to the toilet at night, in the morning, sometimes during natural acts. Precursors and consequences of syncope is almost no remains loop alarm.

About causality sharp decrease in pressure there are many hypotheses:

• release bladder, bowel contents are weighed receptacle, wherein the intensified activity of the vagus nerve;
• straining apnea;
• orthostatic effects after getting up;
• alcohol poisoning;
• hypersensitivity of the carotid sinus;
• the effects of traumatic brain injury;
• weakness after somatic diseases.

Doctors agree that nikturichesky syncope occurs at confluence of negative factors.

Neuralgia glossopharyngeal nerve

Persons older than 50 years of absorption process of eating, yawning, conversation is suddenly interrupted unbearable burning sensation in the tongue, tonsils, soft palate. In some situations, it is projected in the neck joint of the lower jaw. After 20 s, 3 min. the pain disappears, but the person loses consciousness for a short while, sometimes run through the body convulsions.

By neuralgic fainting may lead massage or manipulation in the area of ​​the carotid sinus hypersensitivity, external ear passage, nasopharyngeal mucosa. To avoid this, use drugs based on atropine. Fixed Type 2 neurological syncope - vasodepressor, cardioinhibitory (during braking of the heart).

hypoglycemic syncopations

Lowering of blood sugar level up to 3.5 mmol / l is already unwell. When this index falls below 1.65 mmol / l, the patient loses consciousness, EEG shows attenuation the electrical signals of the brain, that amounts to a violation of tissue respiration due to lack of blood oxygen.

The clinical picture saharodefitsitnogo syncope combined hypoglycemic and vasodepressor reasons.

Aggravating factors are:

• diabetes;
• innate antagonism fructose;
• benign and malignant tumors;
• hyperinsulinism (high insulin levels at a low concentration of sugar) level fluctuations or sugar in connection with violations of the functions of the hypothalamus - the brain department of inland stability.

hysterical syncope

Nervous attacks more likely to occur in people with hysteroid, self-centered character, which by all means seek to rivet the attention of others up to the demonstration of suicidal intent.

One of the tricks to become a central figure in the conflict to win or get what you want - a hysterical psevdoobmorokom. But if egomaniac often exploits this effect, there is a danger that the next will be a real faint.

psevdoskinkope difference:

• skin, normal lip color;
• pulse with no signs of a bradycardia and frequency of oscillations;
• BP data are not understated.

If the "sick" groaned, shudders, it indicates the presence of consciousness. he comes fresh from a seizure, while the surrounding scared.

somatogenic

Diseases or disorders of organs and systems, causing oxygen to starving brain, become causes of syncope somatogenic genesis.

The list of such pathologies:

• heart disease, blood vessels;
• changes in the blood;
• kidney failure, liver, lungs;
• swelling;
• bronchial asthma;
• diabetes;
• infection;
• intoxication;
• starvation;
• anemia.

unknown etiology

Syncope, what it is for the occasional episode, it is extremely difficult to determine. Hardware inspection process of elimination to identify the cause of syncope allows a maximum of half of seeking medical care. The other cases relate to the sphere of influence of the vagus nerve.

syncopal drowning

Doctors recommend not rush into the cold water, as there is a risk of the terminal status - drowning, but not from the lungs fill with water, and due to coronary attack, cerebral blocking circulation. If the victim time to pull out of the water (within 5-6 min.), It can be reanimated.

symptomatology

It is necessary to distinguish between short-term and long fainting loss of consciousness. If a person does not come to more than 5 min., Suggesting, for example, of a stroke from a blood clot or a rupture of the vessel. The patient can slowly, with amnesia to recover, and may fall into a coma.

If the attack lasts 1-2 minutes. - it is easy faint to 3 minutes. - heavy.

Symptoms of syncope summarized as follows:

1. The foregoing signals: Weakness, dizziness; fly, trembling net or darkening of the eyes; noise, ringing in the ears squeak; vatnost in the limbs;
2. Syncope: Sudden pallor; unconscious wandering eyes or closed eyes; pupils are first narrowed, expanded, not responding to visual stimuli; the body goes limp and falls; limbs are cold, covers the entire area of ​​a cold clammy sweat; pulse weak or not groped; shallow breathing, deceleration;
3. Postsinkopalnoe state: Rapid return of consciousness (if the cardiovascular apparatus is normal and there is no damage in the fall); recovery of blood circulation, normal respiration, heart rate, color sheets; disappears after a few hours of weakness, malaise.

Diagnostics

examination of the patient is conducted in 2 directions - cardiovascular and neurology.

The test program includes:

• compiling a history of the frequency and character attacks prenesennym diseases receive drugs;
• X-ray of the heart, lungs, skull;
• ECG, EEG;
• assessment of noise, heart sounds by phonocardiography - sensors and sound amplifiers;
• blood, urine;
• Massage pressure on the carotid sinus (10);
• ophthalmologist's consultation.

If necessary, the computer is assigned to layered imaging of the heart, blood vessels, brain.

First aid for syncope syndrome

When the typical harbingers of syncope need to lie flat and raise the legs. This will ensure the flow of blood to the heart, the head. Feel free to unbutton clothes chest, massaging a point above the upper lip, whiskey.

In case of loss of consciousness before the arrival of doctors help surrounding such actions:

• pick up the limp man;
• laid flat, legs lifted, her head turned to one side, so that the language did not close the access of air;
• open windows, include a fan, free from the breastbone of clothing;
• give to smell ammonia, slapped her cheeks, sprinkle with cold water, rubbing the ears.

Methods of treatment and patient management protocol

Syncope therapy is selected individually according to the root cause and symptoms.

In most cases, the patient is prescribed between the attacks:

• nootropic drugs improving cerebral function, their resistance to stress, hypoxia;
• adaptogens tonicity CNS, and through it the whole body;
• venotoniki;
• vagolitiki blocking the vagus nerve;
• antispasmodics;
• sedatives;
• vitamins.

Treatment Protocol provides for treating the cause and comorbidities. In complex cases, resorting to surgery. If you can not remove the excessive excitation of the vagus nerve and holino- simpatikolitikami, electrophoresis novocaine blockade, radiotherapy is carried out suppression of nerve fibers.

Autonomic disorders corrected periarterial peeling - removing a portion of the outer shell artery, which prevents its expansion. Kardiopatologiyu carotid sinus remove the implantation of pacemakers.

complications

Fainting dangerous strong bruises, the blows of sharp objects. Can tragically result in syncope in patients with impaired cardiovascular, brain activity. There is a risk of development of chronic hypoxia, deterioration in intellectual abilities, coordination.

prevention

Syncope can be avoided if to evade provoking factors - heat, sudden movements, tight clothing, bed with a pillow, crowded places. Easy hypotension manages to neutralize walking, rocking from toe to heel, kneading the muscles, deep breathing. Patients with hypertension need to reduce the dosage of vasodilators.

When vasovagal, orthostatic syncope need things stockings dragging away the lower part of the body and lower extremities.

Since the treatment of the elderly, the elderly difficult contraindications, you need to free them Rooms acute-angled objects, put on the floor a soft coating, to provide support to walks.

Prognosis of syncope depends on the timely medical assistance. Under this condition and the correct way of life have a chance to forget what fainted.

Registration of the article: Lozinski Oleg

Video of syncope

First aid for fainting:

Causes of loss of creation: