What is syncope in an adult, how often does it occur? Signs, causes, treatment

RCHD (Republican Center for Healthcare Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols MH RK - 2016

Fainting [syncope] and collapse (R55)

Emergency medicine

general information

Short description

Approved
Joint Commission on the Quality of Medical Services
Ministry of Health and Social Development of the Republic of Kazakhstan
dated June 23, 2016
Protocol No. 5

Classification

Classification

Reflex (neurogenic) syncope:
Vasovagal:
· Caused by emotional stress (fear, pain, instrumental interventions, contact with blood);
· Caused by orthostatic stress.
Situational:
• coughing, sneezing;
Irritation of the gastrointestinal tract (swallowing, defecation, abdominal pain);
Urination;
· Load;
· Food intake;
· Other reasons (laughter, playing wind instruments, lifting weights).
Carotid sinus syndrome.
Atypical pain (in the presence of obvious tritters and / or atypical manifestations).

Syncope associated with orthostatic hypotension:
Primary autonomic failure:
· Pure autonomic failure, multisystem atrophy, Parkinson's disease, Lewy's disease.
Secondary autonomic failure:
· Alcohol, amyloidosis, uremia, spinal cord injury;
· Drug orthostatic hypotension, vasodilators, diuretics, phenothiosins, antidepressants;
Loss of fluid (bleeding, diarrhea, vomiting).

Cardiogenic syncope:
Arrhythmogenic:
Bradycardia, sinus node dysfunction, AV block, impaired function of the implanted pacemaker;
• tachycardia: supraventricular, ventricular (idiopathic, secondary to heart disease or impaired ion channels);
· Drug bradycardia and tachycardia.
Organic diseases:
Heart (heart defects, acute myocardial infarction / myocardial ischemia, hypertrophic cardiomyopathy, formation in the heart (myxoma, tumors), lesions of the pericardium / tamponade, congenital malformations of the coronary arteries, artificial valve dysfunction;
· Others (pulmonary embolism, dissecting aortic aneurysm, pulmonary hypertension).

Diagnostics (outpatient clinic)

DIAGNOSTICS AT THE AMBULATORY LEVEL **

Diagnostic criteria

Complaints and anamnesis:slow fall, "settling" of the patient, in children: lack of an adequate response to the environment (abruptly inhibited, drowsy, does not respond to sounds and bright objects, light).

Physical examination:sharp pallor of the skin, the pulse is small or undetectable, blood pressure is sharply reduced, breathing is shallow.

Laboratory research:
· UAC;
· Biochemical blood test (ALT, AST, creatinine, urea);
· Blood sugar.

Instrumental research:
· 12-lead ECG - no data for ACS.

Diagnostic algorithm:

The patient is examined according to the following scheme:
Skin: moist, pale
Head and face: no traumatic injuries
Nose and ears: no discharge of blood, pus, cerebrospinal fluid, cyanosis
Eyes: conjunctiva (no hemorrhage, pallor or jaundice), pupils (no anisocoria, reaction to light is preserved)
Neck: no stiff neck
Tongue: dry or wet, no traces of fresh bites
Chest: symmetry, no damage
Belly: size, bloating, sunken, asymmetric, presence of peristaltic noises
Pulse study: slow, weak
Heart rate measurement: tachycardia, bradycardia, arrhythmia
Blood pressure measurement: normal, low
Auscultation: assessment of heart sounds
Breathing: tachypnoe / bradypnoe, shallow breathing
Chest percussion
ECG

Diagnostics (hospital)

STATIONARY DIAGNOSTICS **

Diagnostic criteria at the inpatient level **:
For complaints and anamnesis see outpatient level.
For physical examination see ambulatory level.
Laboratory tests: see outpatient level.

Diagnostic algorithm:see ambulatory level.

List of main diagnostic measures:
UAC
KOS
Biochemical parameters (ALT, AST, creatinine, urea)
ECG

List of additional diagnostic measures:
EEG according to indications: to exclude pathological activity of the cerebral cortex
Echocardiography according to indications: in case of suspected cardiogenic syncope
Holter monitoring according to indications: with an arrhythmic variant of syncope or with suspicion of an arrhythmogenic nature of impairment of consciousness, especially if episodes of arrhythmia are not regular and have not been previously identified
CT / MRI according to indications: in case of suspicion of cerebrovascular accident, craniocerebral injury
X-ray (sighting) in the presence of bodily injuries

Differential diagnosis

Treatment abroad

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Treatment

Preparations (active ingredients) used in treatment

Treatment (outpatient clinic)

TREATMENT AT THE AMBULATORY LEVEL

Treatment tactics **

Non-drug treatment: transfer the patient to a horizontal position, raise his legs (angle 30-45 o), provide access to fresh air and free breathing, unfasten the collar, loosen the tie, splashing cold water on the face.

Drug treatment:
· Inhalation of vapors of ammonia [A]

List of essential medicines:

With hypotension:
· Phenylephrine (mezatone) 1% - 1.0 subcutaneously [A]
· Caffeine sodium benzoate 20% - 1.0 subcutaneously [A]
· Niketamide 25% - 1.0 subcutaneously [C]
With bradycardia:
atropine sulfate 0.1% - 0.5 - 1.0 subcutaneously [A]

List of additional medicines:

If the heart rhythm is disturbed (tachyarrhythmias):
· Amiodarone - 2.5-5 mcg / kg intravenously for 10-20 minutes in 20-40 ml of 5% dextrose solution [A]
If you suspect anaphylactoid genesis of impaired consciousness:
· Prednisolone 30-60 mg [A]
Oxygen therapy
Algorithm of actions in emergency situations:
· If breathing and blood circulation stop, proceed to cardiopulmonary resuscitation.

Other treatments:with cardiogenic and cerebral syncope - treatment of the underlying disease.

Indications for specialist consultation:repeated fainting and ineffectiveness of non-drug treatment methods (endocrinologist, cardiologist, neurologist). The rest are specialists according to indications.

Preventive actions:an increase in fluid intake and table salt, salty foods. Alternating mental and physical stress, especially in adolescents. A good night's sleep, at least 7-8 hours. Sleep with a high pillow is recommended. Exclude alcohol intake. Avoid stuffy rooms, overheating, prolonged standing, straining, throwing the head back. Tilt training - daily orthostatic training. To be able to stop the precursors: take a horizontal position, drink cold water, isometric load on the legs (crossing them) or hands (clenching the hand into a fist or straining the arm) increases blood pressure, fainting does not develop.

Treatment effectiveness indicators:
• restoration of consciousness;
· Normalization of hemodynamic parameters.

Treatment (hospital)

STATIONARY TREATMENT **

Treatment tactics **: see. outpatient level.
Surgical intervention: none.
Other treatments: none.
Indications for specialist advice: see outpatient level.

Indications for transfer to the intensive care unit and intensive care unit:
· Conditions after an episode of respiratory arrest and / or blood circulation.

Treatment effectiveness indicators: see ambulatory level.

Further management:the therapy regimen is individual.

Hospitalization

Indications for planned hospitalization:
· Recurrent syncope of unknown origin;
· Development of syncope during exercise;
• a feeling of arrhythmia or interruptions in the work of the heart immediately before syncope;
• development of syncope while lying down;
Family history of sudden death.

Indications for emergency hospitalization:
· Life-threatening cardiogenic and cerebrovascular syncope;
· Episode of respiratory and / or circulatory arrest;
• not regaining consciousness for more than 10 minutes;
Injuries resulting from a fall during syncope

Information

Sources and Literature

1. Minutes of the meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Healthcare of the Republic of Kazakhstan, 2016
   1. 1. Nikitina VV, Skoromets AA, Voznyuk IA, et al. Clinical guidelines (protocol) for the provision of emergency medical care in fainting (syncope) and collapse. St. Petersburg. 2015.10 p. 2. Emergency conditions in neurology: a methodological guide for students of medical, pediatric faculties and students of postgraduate and additional professional education (Vasilevskaya OV, Morozova EG [Edited by prof. Yakupova EZ]. - Kazan: KSMU , 2011. - 114 pp. 3. Sutton R, Benditt D, Brignole M, et al. Syncope: diagnosis and management according to the 2009 guidelines of the European Society of Cardiology. Pol Arch Med Wewn. 2010; 120: 42-7 4. Stryjewski PJ, Kuczaj A., Braczkowski R., et al. The clinical course of presyncope in the differential diagnosis of syncope. Russian Journal of Cardiology -2015. (9) .- pp. 55-58 5. Brignole M. , Menozzi C., Moya A., Andresen D., Blanc JJ, Krahn AD, Wieling W., Beiras X., Deharo JC, Russo V., Tomaino M., Sutton R. Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial.// Circulation.– 2012.-Vol.125, No. 21. - P.2566-71. 6. Brignole M., Auricchio A., Baron-Esquivias G., et al. ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). //Europace.– 2013.-Vol.15, No. 8. –P.1070-118.

Information

Abbreviations used in the protocol:

Attached files

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Fainting, or syncope or syncope in the language of official medicine, is a short-term impairment of consciousness, usually leading to a fall.

The word syncope is of Greek origin ( syn - with, together; koptein - cut off, cut off), later this word migrated into Latin - syncopafrom which it came into musical terminology (syncope). However, in clinical medicine, it is customary to use terms etymologically related to the Greek language to denote pathological conditions; therefore, the word "syncope" is still more correct.

In some cases, the development of fainting is preceded by a variety of symptoms, which are called lipothymia (weakness, sweating, headache, dizziness, visual impairment, tinnitus, a premonition of an imminent fall), but more often syncope develops suddenly, sometimes against the background of “complete well-being”.

At the same time, the presence of precursors of fainting is not like the aura that accompanies epileptic seizures. Harbingers of fainting are more “earthly” in nature and are never expressed in the form of bizarre sensations: the smell of roses, auditory hallucinations, etc.

Sometimes patients with habitual fainting when lipotimia appears can have time to sit or lie down, cause painful irritations to themselves (pinch themselves or bite their lip), trying to avoid losing consciousness. This often succeeds.

The duration of loss of consciousness during fainting, as a rule, is 15-30 seconds, less often it lasts up to several minutes. Prolonged syncope can be very difficult to distinguish from other illnesses that may be accompanied by impaired consciousness.

Not every time you can distinguish an epileptic seizure from fainting. With prolonged fainting, as with a seizure, twitching of the muscles of the trunk and face may be noted. The only thing is that patients with fainting never bend into an arc - they do not have what is called generalized convulsions (simultaneous convulsive contraction of many muscles).

Causes of syncope

Fainting is caused by a sudden decrease in blood flow to the brain. With a sharp decrease in cerebral blood flow, six seconds may already be enough for the consciousness to turn off.

There may be several reasons for this incident:

• a reflex decrease in the tone of the arteries or disruption of the heart, accompanied by a decrease in the amount of blood expelled from it;
• heart rhythm disturbances (sharp bradycardia or tachycardia, short-term episodes of cardiac arrest);
• changes in the heart, as a result of which there are disorders of the blood flow inside the heart chambers (defects).

The probable causes of fainting differ depending on age; in older people, first of all, violations in the vessels supplying the brain (narrowing of these vessels caused by atherosclerosis), or various heart diseases should be suspected.

For young patients, fainting is more typical, developing as if in the absence of changes in the heart and blood vessels - most often it is fainting, which are based on dysfunction of the nervous system or mental disorders.

In about one third of all cases, the cause of fainting remains unclear, despite testing.

One of the mechanisms for the development of syncope is the so-called orthostatic mechanism, a kind of retribution of a person for walking upright. The principle of orthostatic disorders is insufficient blood supply to the brain due to the victory of the force of attraction and the accumulation of blood in the lower parts of the body. This occurs either due to insufficient vascular tone, or with a decrease in the volume of blood in the bloodstream.

Repeated fainting in a standing position can be in people with long-term diabetes mellitus, since this disrupts the innervation of blood vessels (autonomic diabetic neuropathy), Parkinson's disease, and adrenal insufficiency (the amount of hormones responsible for maintaining blood pressure decreases).

A decrease in the volume of circulating blood can be caused by both bleeding and a decrease in the volume of the liquid part of the blood (for example, severe sweating in the heat, repeated diarrhea, profuse vomiting).

In pregnant women, due to the discrepancy between the amount of blood and the needs of the "doubled" organism, there is also a tendency to fainting.

Orthostatic reactions can be provoked by alcohol consumed in excessive doses and some medications. Medicines that can cause short-term loss of consciousness should be discussed separately.

First of all, these are drugs that lower blood pressure: drugs taken to dilate blood vessels, and diuretics. When prescribing them, the doctor warns that the pressure may drop excessively, so you should not walk for a long time after taking the medicine for the first time or just stand for a long time.

The most common reactions are reactions to drugs based on nitroglycerin, so they should always be taken with great care.

Separately, I would like to warn you: nitroglycerin is a drug intended for the treatment of angina pectoris. It is by no means a universal remedy for the treatment of all cases, while in patients at the time of fainting, sometimes there is a feeling of compression in the region of the heart, stabbing pain and other unpleasant sensations in the chest.

Nitroglycerin, in a hurry stuck under the tongue, will only aggravate an already unpleasant situation. Therefore, in most cases of the development of fainting, it should not be given, and if the need for this medicine is beyond doubt, then it is required to at least approximately estimate the level of blood pressure. With low pressure, the presence of which can be suspected by such signs as a weak pulse, cold and damp skin, nitroglycerin is contraindicated.

Drugs used to treat erectile dysfunction in men (sildenafil, vardenafil and tadalafil) can also contribute to the development of orthostatic reactions. The danger of their simultaneous reception with nitroglycerin is especially indicated - the combined use of these funds can very sharply reduce the level of blood pressure in the vessels due to the sharp expansion of the latter.

A different mechanism is involved in the basis neuroreflex syncope, the appearance of which is associated with irritation of certain reflexogenic zones. A triggered reflex causes a decrease in heart rate and vasodilation, which ultimately leads to a decrease in blood flow in the brain.

Nervous system receptors, irritation of which can lead to fainting, are scattered throughout the body. Ear funnel irritation at the ENT doctor's appointment is one of the typical causes of fainting in medical institutions.

On the neck, not far from the corner of the lower jaw, in the place where the common carotid artery bifurcates, there are carotid sinuses, the irritation of which can cause loss of consciousness. This nuisance primarily concerns men with short necks, for whom the conservative dress code prescribes tight collar fastening, accompanied by a tightening of the tie.

Men can also suffer from irritation of this area with a razor. Once upon a time even the "barber symptom" stood out. Oddly enough, but heavy jewelry (massive earrings or chains) can also provoke fainting, squeezing or sometimes just touching the overly active reflexogenic zone.

Increased pressure in the chest, which occurs when coughing, sneezing or straining, causes fainting in people with over-responsive receptors in the lungs. The sickness that sometimes occurs during breaststroke swimming is also associated with this.

Reflex impulses from the intestines, resulting from banal flatulence, causing even a short-term disturbance of consciousness, makes one think of a serious abdominal catastrophe. The same can be said about reflexes from the bladder when it is overstretched due to urinary retention (associated with illness or even arbitrary).

Also associated with the bladder is such an unpleasant fainting as fainting that occurs in men at the time of urination. Anatomically, the urethra in a man is several times longer than in a woman, the resistance to the flow of urine is again higher, and the reasons for increasing this resistance are found more often (prostate adenoma, for example). And then, having experienced several loss of consciousness, the man has to adapt to the situation that has arisen (for example, urinate while sitting).

Syncope states that develop against the background of erotic stimulation or against the background of orgasm look quite "romantic". Alas, they are not associated with an emotional outburst, but with the activation of reflexogenic areas of the genitals.

In addition to vasodilation and a decrease in cardiac output, the cause of loss of consciousness can be heart rhythm disturbances... Of all situations, these are the most dangerous for the patient, since they pose the greatest risk to life.

The fact is that some rhythm disturbances that do not initially lead to cardiac arrest can, after a few seconds or minutes, cause a potentially fatal disorder, when the fibers of the heart "twitch" in different directions, without carrying out any coordinated activity and not "driving" blood through the vessels. This disorder is called fibrillation.

It follows that any disturbances in the heart rhythm that have become the cause of impaired consciousness should be considered very seriously and be a reason for admission to a hospital for the purpose of both an in-depth examination and the choice of treatment or even surgery.

Diseases of the heart and lungs that cause transient disorders of consciousness are a rather heterogeneous group of diseases. It can be lesions of the heart valves, in which there is a violation of intracardiac blood flow, and pulmonary disorders, when an obstacle to normal blood flow occurs already in the area of \u200b\u200bthe pulmonary circulation.

Finally, lesions of the vessels directly feeding the brain can also lead to fainting. The cause of fainting is both internal obstructions to the blood flow (large atherosclerotic plaques, for example) and compression of a large vessel by something from the outside.

According to current ideas, not all short-term disorders of consciousness are usually attributed to the group of syncope. The nature of loss of consciousness during epileptic seizure, heat or sunstroke, hyperventilation disorder (acute panic attack accompanied by deep and rapid breathing) is non-syncopal.

A disease such as syncope migraine stands out separately. Being similar to migraine in its main manifestation - headache, it has one fundamental difference. If an attack of a classical migraine is also resolved classically - with severe nausea and vomiting, bringing immediate relief, then with syncope migraine, the apotheosis of the attack is not vomiting, but fainting. When he wakes up, the patient realizes that the headache has disappeared somewhere or almost disappeared.

For example, a rare diagnosis such as myxoma (a tumor that grows into the lumen of the heart on a thin pedicle) may be suspected if syncope develops when turning from side to side. This is because a tumor that "dangles" quite freely in the lumen of the heart chambers at certain positions can block the blood flow through the heart valve.

In syncope, stereotypically occurring during bowel movements, urination, coughing or swallowing, one speaks of situational fainting.

The situation when syncope is associated with throwing the head back (as if the patient wanted to look at the ceiling or at the stars) is called the Sistine Chapel syndrome and can be associated with both vascular pathology and hyperstimulation of carotid sinus zones.

Syncope conditions occurring during physical exertion make it possible to suspect the presence of stenosis of the outflow tract of the left ventricle.

Determining the cause of syncope can be greatly assisted by the correct collection of complaints and medical history. The key points to evaluate are as follows:

• establishing a posture in which syncope developed (standing, lying, sitting).

• clarification of the nature of the actions that led to syncope (standing, walking, turning the neck, physical exertion, defecation, urination, coughing, sneezing, swallowing).

• previous events (overeating, emotional reactions, etc.)

• identification of precursors of syncope (headache, dizziness, "aura", weakness, visual impairment, etc.). Separately, you should find out the presence of symptoms such as nausea or vomiting before loss of consciousness. Their absence makes one think about the possibility of developing heart rhythm disturbances.

• clarification of the circumstances of the syncope episode itself - the duration, nature of the fall (supine, "sliding" or slow kneeling), the color of the skin, the presence or absence of cramps and biting the tongue, the presence of respiratory disorders.

• characteristics of resolution of syncope - presence of lethargy or confusion, involuntary urination or defecation, discoloration of the skin, nausea and vomiting, palpitations.

• anamnestic factors - family history of sudden death, heart disease, fainting; a history of heart disease, lung disease, metabolic disorders (primarily diabetes mellitus and adrenal pathology); taking medications; data on previous syncope and examination results (if any).

In all cases of the development of fainting conditions, it is necessary to make an electrocardiogram (if not immediately, then later). The fact is that a number of diseases that can cause a disturbance in the rhythm of the heart, leading to loss of consciousness, are detected precisely with an ECG. In the worst case, loss of consciousness can be the onset of the development of myocardial infarction, which is also diagnosed on the basis of an ECG.

To confirm the orthostatic origin of syncope, an elementary blood pressure test can be performed. The first measurement is taken after the patient has been in the supine position for five minutes. The patient then stands up and measurements are taken after one and three minutes.

In cases where the decrease in systolic pressure is more than 20 mm Hg. Art. (or below 90 mm Hg) is fixed in the first or third minutes, the sample should be considered positive. If the pressure drop indicators do not reach the indicated values, but by the third minute the pressure continues to decrease, measurements should be continued every two minutes, either until the indicators stabilize, or until critical figures are reached. Naturally, this test should be performed by a doctor.

Even if the usual test with the measurement of pressure did not give a result, suspicions of an orthostatic origin of fainting may still remain. For the final solution of a questionable issue, a "tilt test" is performed (from the English, to tilt - tilt).

The patient is placed on a table and attached to this table so that when the table is tilted, he remains in a kind of "crucified" position. The table is tilted, the patient is, as it were, "put" on his feet, while determining changes in blood pressure during the transfer to the vertical position. A rapid decrease in blood pressure (and, in rare cases, the development of light-headedness) confirms the diagnosis of orthostatic syncope.

Blood pressure measurements should be taken on both hands. If the difference exceeds 10 mm Hg. Art., one can suspect the presence of aortoarteritis, subclavian artery syndrome or dissection of an aneurysm in the aortic arch, i.e. diseases, each of which can lead to uneven blood flow in the brain system, and each of which requires medical intervention.

Normally, for any person, the pressure difference can reach 5-10% on two hands, but if these differences have become larger, have grown or appeared for the first time in life, it makes sense to consult a doctor.

Treatment

Vasovagal syncope and other manifestations of neuroreflex syndrome require exclusively general measures - the patient should be placed in a place as cool as possible, with open access to fresh air, unbuttoned tight clothing or squeezing accessories (belt, collar, corset, bra, tie), give the legs an elevated position ...

Turning the head to one side in order to prevent tongue sinking is allowed only if it is certain that there is no damage to the subclavian, carotid and vertebral arteries.

The application of painful stimuli (slaps, for example), as a rule, is not required - the patient soon regains consciousness himself. In protracted cases, a cotton swab with ammonia, brought to the nose, or simply tickling the mucous membrane of the nasal passages, can accelerate the return of consciousness. The last two actions lead to the activation of the vasomotor and respiratory centers.

In a situation where the previous profuse sweating has led to the development of fainting, you should simply replenish the volume of fluid - give an abundant drink. The universal remedy for the treatment of post-faintness is tea - liquid plus caffeine, which maintains vascular tone and cardiac output, plus sugar, which is necessary in view of possible hypoglycemia (low blood glucose).

Most syncope does not require specific drug therapy. Young patients prone to orthostatic reactions may be advised to increase the amount of salty foods; occasionally, drugs that maintain vascular tone are prescribed.

Hospitalization

It is not required to admit patients with "habitual" or "situational" fainting, previously examined, and not causing concern for further prognosis, to the hospital.

Patients are subject to hospitalization in order to clarify the diagnosis:

• with suspected heart disease, including with changes in the ECG;
• the development of syncope during exercise;
• a family history of sudden death;
• sensations of arrhythmia or interruptions in the work of the heart immediately before syncope;
• recurrent syncope;
• the development of syncope while lying down.

Patients are subject to hospitalization for treatment:

• with rhythm and conduction disturbances leading to the development of syncope;
• syncope, probably caused by myocardial ischemia;
• secondary syncope in diseases of the heart and lungs;
• the presence of acute neurological symptoms;
• irregularities in the work of a permanent pacemaker;
• injuries resulting from a fall during syncope.

Reflex syncope is a heterogeneous group of conditions in which cardiovascular reflexes, which normally control hemodynamics, are temporarily impaired. As a result, vasodilation or bradycardia develops, which leads to a drop in systemic blood pressure and a deterioration in cerebral perfusion.

To simplify the diagnosis, reflex syncope is divided either according to the mechanism of occurrence (vasodepressor, cardio-inhibitory, etc.), or taking into account the trigger (situational syncope). The term “atypical syncope” is used when the triggers of reflex syncope cannot be identified. The diagnosis is made by taking a history and excluding other causes of fainting (absence of organic heart disease) or a positive tilt test.

1.1. Vasovagal (simple, vasomotor) syncope

It is the most common cause of short-term loss of consciousness and is, according to various researchers, from 28 to 93% of all patients with syncope. It occurs at any age, more often in the young and less often in the old.

For the first time the clinical picture of vasovagal syncope was described in 1932 by T. Lewis in a young soldier.

Mechanism. Under the influence of stress, reflexogenic zones are activated, causing bradycardia and vasodilation (mainly of muscle vessels).

Cause. Fright and anxiety associated with unpleasant news most often act as a stress factor; type of blood; waiting for medical procedures (such as dental procedures or intravenous injection).

Aggravating factors. Among the conditions contributing to the onset of vasovagal syncope, the most common factor is the orthostatic factor (prolonged standing in transport, queuing, etc.) In addition, being in a stuffy room causes hyperventilation as a compensatory reaction, which is also an additional strong provoking factor. Other factors: fatigue, lack of sleep, fever, alcohol consumption.

Symptoms Before fainting, patients complain of cloudy eyes, a feeling of lack of air (a desire to breathe deeply), discomfort of emptiness in the upper abdomen. During fainting, the patient is motionless, the skin is pale and cold, covered with sweat. Examination reveals bradycardia, low systolic blood pressure. The horizontal position of the patient leads to the restoration of consciousness and an increase in blood pressure.

Important points:

• The presence of provoking (stressful) factors.
• Presence of a pre-faint period: anxiety, weakness, yawning, pallor, darkening in the eyes.
• Loss of muscle tone with vasovagal syncope occurs gradually, so the patient does not fall as if knocked down, but sinks to the ground.
• During the period of loss of consciousness - arterial hypotension and bradycardia, during the recovery period - compensatory tachycardia.
• Warm and moist skin during the recovery period due to dilatation of small vessels.

Diagnosis. Vasovagal syncope is diagnosed if it is caused by emotional or orthostatic stress and a characteristic pre-syncope is present (grade I, grade C).

By vasovagal syncope is meant short-term memory loss caused by the expansion of blood vessels against the background of a decrease in heart rate. Being in this state, a person cannot maintain a certain posture for a long time. Vasovagal syncope is not a health hazard. However, frequent bouts of loss of consciousness impair quality of life. The first fainting spells of a similar nature appear in childhood, over time their symptoms remain unchanged.

What is vasovagal syncope

Short-term loss of consciousness with vasovagal syncope occurs when a person takes an upright position. Similar phenomena occur due to stimulation of the vagus nerve that innervates the chest, neck and intestines.

Like other types of syncope, vasovagal develops against the background of a sharp decrease in blood flow to the brain due to the influence of a number of provoking factors: stress, nervous tension, fear, and more.

Loss of consciousness occurs due to the fact that the described processes contribute to the expansion of blood vessels, which leads to a decrease in blood pressure and heart rate (bradycardia). As a result, the brain experiences oxygen starvation.

Kinds

In medicine, it is customary to divide vasovagal syncope into two types.

Classical

Loss of consciousness is accompanied by phenomena characteristic of other types of fainting conditions. Most often, the classic type occurs against the background of emotional disturbances (fear, strong emotions, etc.), or a long stay in an upright position. It is detected mainly in young people under 30 years old.

Non-classical

This type of vasovagal syncope is diagnosed in cases where it is impossible to determine the provoking factor. Loss of consciousness in this scenario occurs mainly in the elderly.

The reasons

The main cause of vasovagal syncope is an abnormal reaction of the body to the influence of the external environment, which has a stimulating effect on the receptors of the autonomic nervous system. The latter is responsible for the work of internal organs.

Modern medicine has not fully clarified the question of what changes in the body lead to loss of consciousness. It is believed that vasovagal syncope develops with stimulation of the vagus nerve. This theory is supported by the fact that when such conditions occur, the heart rate decreases.

There is also an opinion that instant inhibition of the sympathetic part of the nervous system, which regulates the autonomic system, can lead to loss of consciousness. This explains why the blood vessels dilate when fainting.

Moreover, each of the processes described above is activated under the influence of one or more provoking factors:

• strong emotional voltage, arising from the sight of blood, due to fear, and so on;
• painful Feel;
• being in vertical condition for a long period of time;
• abrupt cessation of physical exercise;
• wearing tight ties or collars;
• overeating;
• long stay in stuffy indoors, in a hot bath;
• compliance diets, starvation;
• abuse of harmful habits;
• chronic condition tiredness;
• depression;
• heart pathology;
• tumor education.

Persons suffering from cardiovascular diseases are highly discouraged from staying in hot rooms or in direct sunlight for a long time. This situation contributes to the violation of blood flow, in connection with which there are drops in blood pressure.

Fainting against the background of prolonged fasting is provoked by a lack of vitamins and minerals. The latter leads to a decrease in the level of hemoglobin and blood sugar, as a result of which a malfunction of the internal systems occurs.

Under the influence of loads of a different nature (physical and psycho-emotional), the body, trying to compensate for the lack of important elements, slows down for a while some of its functions.

Any bad habits negatively affect the condition of the blood vessels, which increases the risk of malfunctioning of the cardiovascular system. The result of these processes is vasovagal syncope. Similar phenomena occur with chronic lack of sleep and fatigue. In this case, fainting fulfills the compensatory function of the body, in which blood flow is disturbed.

Vasovagal syncope is dangerous only when there is a possibility of injury to the head and limbs when falling. In this case, a sudden loss of memory signals a failure in the work of the whole organism or its individual parts.

Symptoms

The development of vasovagal syncope occurs in two stages. Initially, several symptoms appear at once, indicating an imminent loss of consciousness:

• sharp blanching skin;
• intense discharge of cold sweat;
• loss of strength which is initially observed in the limbs and then spreads to the whole body;
• dizziness;
• noise in the ears;
• organ disorders gastrointestinal path;
• painful sensations appearing in the chest area;
• feeling fast palpitations;
• occurrence tunnel vision, in which a person sees only those objects that are located in front;
• increase or decrease pulse.

The second stage is characterized by short-term loss of consciousness. In some people, the symptoms described above do not ultimately lead to fainting.

Diagnostic methods

After the onset of vasovagal syncope, it is recommended to seek medical attention, since a sudden loss of consciousness may indicate serious disturbances in the functioning of the internal systems. In particular, it can be cardiovascular pathologies and malignant neoplasms.

In order to establish the true cause that led to the loss of consciousness, the doctor takes the following measures:

1. Collection information about the current condition of the patient and the main symptoms. It is important in terms of establishing the causes of fainting is to identify the initial phenomena that preceded the loss of consciousness.
2. Analysis the patient's life. The doctor asks about the professional duties of the patient, concomitant pathologies and medications that he takes.
3. Collecting information about family pathologies. This stage is important, since it has been established that vasovagal syncope in about 30% of cases is due to a hereditary predisposition.
4. External inspection the patient, during which the condition of the skin, the respiratory rate is assessed. Additionally, the doctor listens to the lungs and heart.
5. General analysis blood and urine.
6. Biochemical blood test. It allows you to determine the level of cholesterol, sugar, potassium and other elements.

If the last analyzes did not show any deviations, then other diagnostic measures are additionally carried out to identify concomitant pathologies or to exclude them.

Electrocardiography

It is prescribed to assess the performance of the heart muscle.

Holter daily monitoring of electrocardiogram (HMECG)

The procedure lasts from 24 to 72 hours, during which ECG readings are regularly analyzed. Particular attention is paid to the changes that occur on the electrocardiogram during fainting.

Echocardiography

Vasovagal syncope does not affect echocardiography readings. This procedure is carried out in order to exclude cardiac pathologies.

Orthostatic test (titl test)

It is this examination method that makes it possible to identify vasovagal syncope. During the procedure, which lasts no more than half an hour, the patient is placed on a special bed set at an angle of 60 degrees. The patient is connected to a device through which the work of the heart muscle is assessed.

Additionally, blood pressure indicators are measured. After loss of consciousness, there is a sharp decrease in blood pressure and a short-term cardiac arrest (there is a pause).

If necessary, an examination by a neurologist is carried out. To exclude the presence of epilepsy and tumors, which can also provoke loss of consciousness, allow electroencephalography and MRI, respectively.

Therapeutic activities

The treatment regimen for vasovagal syncope is determined based on the severity of the underlying disease. Basically, therapeutic intervention is applied to patients who often face short-term loss of consciousness.

In cases where the problem under consideration arises due to pathologies of a mental nature, the treatment regimen is determined depending on the status of the underlying disease.

Therapy for vasovagal syncope consists of several approaches.

Drug treatment

The patient is prescribed the following drugs:

• Alpha adrenergic agonists. They contribute to the narrowing of blood vessels.
• Beta blockers. These drugs block specific receptors in the body that are activated by stress hormones (adrenaline and norepinephrine).
• M-anticholinergics. Prescribed for the treatment of bradycardia.

Surgical intervention

It is used in the presence of heart disease and tumors. Surgical intervention, during which, in the presence of appropriate indications, a pacemaker is introduced, is carried out under the following conditions:

• age the patient is over 40 years old;
• vasovagal syncope occurs with regular frequency;
• lack of initial symptoms, indicative of an imminent loss of consciousness;
• after fainting was recorded stop hearts.

Lifestyle change

You can prevent another loss of consciousness if you follow these recommendations:

• drink at least two liters of liquid per day;
• exclude heavy physical loads;
• to avoid emotional overvoltage;
• sleep at least eight hours a day;
• refuse to wear tight linen, replacing it with compression;
• regularly perform exercises, aimed at strengthening the mental state.

Special isometric exercises are also used, through which you can increase blood pressure for a short period of time:

• Holding in hand ball, you need to squeeze your palm. The action promotes the outflow of venous blood.
• Hands clasp in lock, and then forcefully pull in opposite directions.
• Standing legs interbreed after which they must be strained.

In case of a sudden loss of consciousness, the person must be placed on his back, raising his legs above his head. This position increases blood flow to the brain.

Vasovagal syncope is not dangerous to humans. It only causes two types of complications:

• trauma, arising from a fall;
• deterioration in quality life in cases where fainting occurs frequently.

Preventive measures allow to prevent the next loss of consciousness.

Prevention measures

In order to prevent vasovagal syncope, first of all, it is necessary to avoid psycho-emotional stress. In particular, these include both conflict situations that can cause stress and prolonged standing in an upright position. At the same time, active outdoor activities are used as preventive measures to prevent loss of consciousness: walking, running and so on.

You can also prevent the onset of another fainting spell:

• hardening or a contrast shower (strengthens blood vessels);
• compliance with the regime days;
• duration sleep for at least 8 hours;
• regular use herbal tea, red wine, or coffee to restore blood pressure;
• drinking tea from chamomile, lemon balm or St. John's wort, which has a positive effect on the nervous system.

Vasovagal syncope is not a dangerous phenomenon, which, however, may indicate serious pathologies: cardiovascular diseases, tumors. You can cope with such phenomena by changing your lifestyle.

Many people have had to deal with fainting; they occur for various reasons and can occur at any time. The main provoking factor is a problem with cerebral blood flow. It is vasovagal syncope that is the most common reason for seeking medical attention.

It is mainly encountered by people at a young age, the pathology arises due to a sudden drop in blood pressure, as well as problems with the heart rhythm. You should know the features of this fainting so that the right measures can be taken.

What is syncope and its neurological assessment

As already mentioned, with syncope, a short-term loss of consciousness occurs. In this case, muscle tone decreases, and the functions of the cardiovascular and respiratory systems are impaired.
Syncope can occur at any age. Usually occurs while sitting or standing. They are caused by acute stem or cerebral oxygen starvation.

Syncope should be distinguished from acute cerebrovascular accident. In the first case, spontaneous recovery of cerebral functions is observed without the manifestation of residual neurological disorders.

Neurologists distinguish between neurogenic and somatogenic syncope.

What is it

Fainting is a sudden loss of consciousness that is triggered by a temporary disruption in blood flow.... As a rule, a person quickly recovers, and all body functions return to normal. In some cases, patients suffer from semi-syncope. In such a situation, a person almost loses consciousness, but at the same time remains on his feet.

Directly with vasovagal syncope, vasodilation occurs, as well as a slowdown in the heart rate. Because of this, a person loses consciousness, but then quickly comes to his senses.

The disease is not considered life-threatening, but it can significantly degrade its quality. Such phenomena are often encountered even in childhood, and the nature of the attacks can change over the years.

Development stages - from fright to hitting the floor

Syncope condition develops in three stages:

• prodromal (stage of precursors);
• direct loss of consciousness;
• post-fainting state.

The severity of each of the stages, its duration depends on the cause and mechanism of development of syncope.

The prodromal stage develops as a result of the action of a provoking factor. It can last from a few seconds to tens of hours. Arises from pain, fright, stress, stuffiness, etc.

It is manifested by weakness, paleness of the face (it can be replaced by redness), sweating, ringing in the ears and head, darkening in the eyes. If a person in this state has time to lie down or at least bow his head, then fainting does not occur.

Under unfavorable conditions (inability to change the position of the body, continued exposure to provoking factors), general weakness increases, consciousness is impaired. Duration - from seconds to ten minutes. The patient falls, however, significant physical damage does not occur, foam at the mouth or involuntary miction is not observed. Pupils dilate, blood pressure falls.

Fainting is characterized by the preservation of the ability to navigate in time and space. However, lethargy and weakness persist.

Treatment

The methods of therapy will depend on what causes the appearance of an inductive syncope. If they are not due to various pathologies, then special measures will not have to be taken.

In some cases, vasoconstrictor drugs are used, as well as beta-blockers. In general, care should be taken to prevent loss of consciousness when vasodepressor syncope occurs. At a minimum, stuffy places and provoking factors should be avoided. If syncope is repeated regularly, then you will need to go through a thorough diagnosis and revise your lifestyle.

Classification subspecies of syndromes

The classification of syncope is very complex. They are distinguished according to the pathophysiological principle. It should be noted that in a significant number of cases, the cause of syncope cannot be determined. In this case, one speaks of idiopathic syncope syndrome.
The following types of syncope also differ:

1. Reflex... This includes vasovagal, situational syncope.
2. Orthostatic... They arise due to insufficient autonomic regulation, taking certain medications, drinking alcoholic beverages, and hypovolemia.
3. Cardiogenic... In this case, the cause of syncope is cardiovascular pathology.
4. Cerebrovascular... They arise due to blockage of the subclavian vein by a thrombus.

Non-syncope pathologies are also distinguished, but they are diagnosed as syncope. Complete or partial loss of consciousness during a fall occurs due to hypoglycemia, epilepsy, poisoning, ischemic attacks.

There are non-syncopal states without loss of consciousness. These include short-term muscle relaxation due to emotional overload, panic attack, psychogenic pseudosyncope, and hysterical syndromes.

The main causes of pathology

The causes of vasovagal syncope are different.

Vasovagal syncope is a pathological condition that develops as a result of an incorrect reaction of the body to external stimuli. The main reasons for this condition include:

• excessive emotions - their role can be played not only by fear, but also by joy;
• excitement before donating blood, fear of pain with intravenous injection;
• prolonged standing, which impedes venous outflow from the lower extremities;
• abruptly stopped moderate physical activity;
• collar / tie too tight;
• prolonged fasting / exhaustion;
• a constant lack of sleep at night;
• prolonged depression, chronic stress;
• chronic fatigue syndrome;
• pathology from the myocardium;
• malignant neoplasms of various organs;
• overheating as a result of taking too hot and prolonged baths, prolonged exposure to the sun or in the sauna;
• overeating.

Since the causes of loss of consciousness are few, it is possible that they should be identified on their own in order to prevent the recurrence of fainting. If you have difficulty with this, it is better not to postpone the visit to the doctor, since sudden loss of consciousness is fraught with injuries when falling.

Etiology and pathogenesis

The causes of syncope are reflex, orthostatic, cardiogenic, and cerebrovascular. The following factors influence the development of syncope:

• the tone of the blood vessel wall;
• level of systemic blood pressure;
• the age of the person.

The pathogenesis of different types of syncope syndromes is as follows:

1. Vasovagal syncope-syncope or vasodepressor states occur due to disorders of vascular autonomic regulation. The tension of the sympathetic nervous system increases, which increases the pressure and heart rate. In the future, due to an increase in the tone of the vagus nerve, blood pressure drops.
2. Orthostatic syncope occurs most often in older people. They are increasingly showing a discrepancy between the volume of blood in the bloodstream and the stable work of the vasomotor function. The development of orthostatic syncope is influenced by the intake of antihypertensive drugs, vasodilators, etc.
3. Due to a decrease in the volume of cardiac output, cardiogenic syncope.
4. With hypoglycemia, a decrease in the amount of oxygen in the blood develops cerebrovascular syncope. Elderly patients are also at risk due to the likelihood of developing transient ischemic attacks.

Mental illness over 45 years of age increases the frequency of recurrent syncope.

Symptoms of vasovagal syncope

It is difficult to independently determine the type of fainting that can develop quite rapidly. In most cases, vasovagal syncope develops with the following symptoms:

• sweating, tinnitus, nausea suddenly develops;
• darkening appears in the eyes, flies or shroud may be noted;
• the skin turns pale;
• decreased heart rate;
• drop in blood pressure;
• dyspeptic disorders are possible.

A distinctive feature of vasovagal fainting is the fact that it cannot develop in the prone position of a person, and if, when suspected of it, the person takes a horizontal position, the development of symptoms stops, fainting does not occur. At the same time, the patient may be bothered for some time with slight dizziness, which goes away on its own.

Classic vasovagal syncope lasts only a few minutes, after which the patient wakes up on his own. If this does not happen, you need to immediately call an ambulance, remembering that during the fall, a person could receive a serious head injury.

There is a risk of injury during the fall

Features of the clinical picture

Features of the clinical course of different types of syncope are as follows:

1. Vasovagal or vasodepressor syncope occurs against a background of stress, a person's stay in stuffy rooms, when exposed to a pain factor, etc. Also, the predisposing factors for the development of such a condition are blood loss, hyperthermia. Before the attack itself, there may be nausea, abdominal pain, etc.
2. Orotostatic fainting is manifested by a feeling of dizziness, nausea. When returning to a horizontal position of the body, such signs usually disappear. During the first three minutes after the body moves to an upright position, there may be dizziness and even loss of consciousness.
3. When cardiogenic syncope before loss of consciousness, the patient often feels weak, chest pain. Loss of consciousness often occurs when a person is sitting or standing for a long time.
4. As already noted, cerebrovascular syncope is associated with conditions such as hypoglycemia, oxygen deprivation, etc. In some cases, a person experiences signs such as double vision, dizziness, visual impairment.

Varieties

There are 2 types of vasovagal syncope. It will be important for the doctor to determine their type in order to understand exactly how to act in a particular situation. Therefore, one should understand the existing types of pathology.

What are the vasovagal syncope:

• Typical

In this case, there are characteristic symptoms for an early loss of consciousness. Rarely enough, injuries can occur due to this pathology. When a person feels that he will soon lose consciousness, he begins to feel limp and gradually sinks to the ground.

• Atypical

In this case, the characteristic symptoms for a quick fainting do not appear. This means that a person loses consciousness suddenly, and even then does not understand what happened. In this regard, various injuries can occur, which can cause serious damage to health.

Moreover, this type of vasovagal syncope is never fatal, unless a life-threatening injury occurs.

Regardless of the species, care should be taken to provide therapy to improve the quality of life. It should be noted that there is vasodepressor syncope, which manifests itself with a negative impact of external factors.

In this situation, the nervous system is present in the pathology mechanism. Only a doctor will be able to say unequivocally what kind of fainting a person had to face.

Diagnostic criteria

First of all, the collection of anamnesis is of great importance for the diagnosis of syncope. It is extremely important for the doctor to find out in detail such circumstances: whether there were precursors, what kind of character they had, what kind of consciousness the person had before the attack, how quickly the clinical signs of syncope grew, the nature of the patient's fall directly during the attack, his complexion, the presence of a pulse, character changes in the pupils.

It is also important to tell the doctor how long the patient has been in a state of loss of consciousness, the presence of seizures, involuntary urination and / or defecation, and foam from the mouth.

When examining patients, the following diagnostic procedures are performed:

• measure blood pressure while standing, sitting and lying;
• carry out diagnostic tests with physical activity;
• do blood and urine tests (required!), determining the amount of blood sugar, as well as hematocrit;
• do also electrocardiography, electroencephalography, ultrasound;
• if there is a suspicion of cardiac causes of syncope, an X-ray of the lungs, ultrasound of the lungs and heart are taken;
• also shown computer and magnetic resonance diagnostics.

It is important to distinguish between syncope and epileptic seizure. Typical differential signs of syncope:

• dependence on the vertical position of the body;
• frequency of attacks during the day;
• occurs more often from a painful attack or emotional overload;
• harbingers are usually noticeable and long lasting, in contrast to, say, an epileptic seizure;
• the skin is pale;
• decreased muscle tone;
• very rarely there are body injuries, urinary incontinence and confusion after the seizure is over;
• symptoms of focal lesions are not observed;
• no amnesia, no changes in the electroencephalogram;
• when the person returns to a horizontal position, the signs of syncope disappear.

The reasons

If a vasovagal syncope occurs, there will always be reasons for this. They must be clarified so that loss of consciousness can be avoided as much as possible. You will also need to make sure that the person does not have any serious pathologies. Because if they are available, it will be important to immediately undergo a full diagnosis and start the correct treatment.

Provoking factors:

• Vivid emotions are usually negative... It can be fear, fear, phobia. Some people may faint from seeing blood. For others, it happens due to being at a height, so the situations are different.
• Strong pain, as well as obtaining blood for analysis from a finger or vein.
... For example, it can be climbing stairs, or training on a stationary bike.
• Using tight ties and tight jewelry... It is desirable that there is no feeling of compression of the neck by foreign objects.
• Visit to the dentist or other doctor... A person may be afraid of painful sensations, or be very worried about the upcoming procedure.
• -Panic attacks-... A sufficient number of people are faced with this problem, especially at a young age. An increased sense of fear can lead to vasovagal syncope. In such a situation, a person's well-being will quickly improve after losing consciousness, and everything will start with a panic attack.
• Prolonged standing... This is especially true for those cases when a person practically does not move. Therefore, vasodepressor fainting may appear even when a person is standing in line or on public transport.

This syncope can also occur with existing medical conditions. These can be myocardial pathologies, chronic fatigue syndrome, prolonged depression, exhaustion, and malignant tumors.

The appearance of vasovagal syncope is also possible in a situation when a person has problems with blood circulation, or he constantly overeats. All this will lead to the fact that it will be possible to face loss of consciousness.

Assistance tactics and strategies

The choice of treatment tactics primarily depends on the cause that caused the syncope. Its purpose is, first of all, to provide emergency care, to prevent the occurrence of repeated episodes of loss of consciousness, and to reduce negative emotional complications.

First of all, when fainting, it is necessary to prevent the person from hitting. He must be laid down and his legs should be placed as high as possible. Unbutton tight clothing and provide sufficient fresh air.

It is necessary to give a sniff of ammonia, spray your face with water. It is necessary to monitor the person's condition, and if he does not wake up within 10 minutes, call an ambulance.

In severe fainting, Metazone is administered orally in a 1% solution or Ephedrine in a 5% solution. An attack of bradycardia, fainting, is stopped by the introduction of Atropine sulfate. Antiarrhythmic drugs should only be administered for cardiac arrhythmias.

If a person has come to his senses, you need to reassure him and ask him to avoid the influence of predisposing factors. It is strictly forbidden to give alcohol, overheat. It is useful to drink plenty of water with the addition of table salt. Avoid sudden changes in body position, especially from horizontal to vertical.

Therapy between attacks is reduced to taking the recommended medications. Non-drug treatment is reduced to the abolition of diuretics, dilators. With hypovolemia, correction of this condition is indicated.

Diagnostics

While vasovagal syncope is not dangerous by itself, it can impair quality of life. We are talking about those situations when syncope occurs more than 3 times a year... Moreover, if a person does not know how to behave correctly when fainting, he can get various injuries. They appear when you fall, so it is extremely important to sit down before losing consciousness, or better to lie down.

Finding the cause of the causative syncope requires a series of simple tests. They will allow you to assess the state of the body, as well as to understand why the pathology has appeared. If necessary, it will be possible to monitor the development of the disease, as well as determine what measures should be taken.

To begin with, the doctor will listen to the patient's complaints about when the fainting appeared, how it proceeds, and also what the patient associates with it. In addition, you will have to analyze a person's life and the fact whether it is associated with great risk.

You will need to find out about whether close relatives had any diseases, whether they had vasovagal fainting. Also, the doctor will conduct a standard examination to detect wheezing in the lungs, heart murmurs and other external pathologies.

You will need to undergo the following examinations:

• General and biochemical blood test. These studies will make it possible to find out whether a person has any deviations from the norm. Based on the indicators, it will be possible to assume possible diseases.
• An EKG is done to check how the heart is working.
• Echocardiography is needed to assess the state of the vessels in vasovagal fainting.
• The tilt test is performed in a special bed, in which the person will be at an angle of 60 degrees. The test is performed within 30 minutes. All this time, the indicators of the heart and blood pressure are recorded.

Based on the test results, it will be possible to make a diagnosis such as vasovagal syncope... If necessary, a person will have to undergo additional examinations and visit other specialists, for example, a neurologist. After that, it will be possible to draw a final conclusion about the patient's well-being. It is important to know how to provide first aid for fainting.

Preventive actions

First of all, the prevention of any syncope is reduced to the elimination of any provoking factors. These are stressful conditions, heavy physical exertion, emotional states.
It is necessary to go in for sports (naturally, in reasonable measures), temper, establish a normal working regime. In the morning, do not make excessively sudden movements in bed.

With frequent fainting and excessive excitability, it is necessary to drink soothing infusions with mint, St. John's wort, lemon balm.

Any type of syncopal syndrome requires increased attention, as sometimes its consequences can be very serious.

Vasovagal syncope: what is it?

Vasovagal syncope is an episode of short-term loss of consciousness caused by reflex vasodilation and a slowing of the heart rate as a result of increased excitability of the vagus nerve. Syncope is usually preceded by prodromal signs (dizziness, palpitations, pallor) and weakness during the recovery period. Fainting is accompanied by falls, prone to recurrence. Diagnostic measures include clinical examination, orthostatic tests, ECG monitoring. Treatment is carried out by non-drug, pharmacological, invasive methods.

Short-term loss of consciousness with vasovagal syncope occurs when a person takes an upright position. Similar phenomena occur due to stimulation of the vagus nerve that innervates the chest, neck and intestines.

Like other types of syncope, vasovagal develops against the background of a sharp decrease in blood flow to the brain due to the influence of a number of provoking factors: stress, nervous tension, fear, and more.

Loss of consciousness occurs due to the fact that the described processes contribute to the expansion of blood vessels, which leads to a decrease in blood pressure and heart rate (bradycardia). As a result, the brain experiences oxygen starvation.

• ICD 10 code: R55

The cause of fainting is the body's defense system or illness

The most common hypothesis of the pathophysiology of vasovagal syncope suggests that the vasovagal reflex is common to all vertebrate species and should be considered not as a real disease, but as a human feature.

Of course, such a reaction, which has existed for millions of years, has a protective function aimed at protection of the heart muscle.

Indeed, inhibition of the sympathetic system, combined with activation of the vagus nerve system, allows the heart to "rest" and conserve oxygen in a situation that requires a high flow rate. It should be noted that in animals, although there is also a vasovagal reaction (decreased blood pressure and bradycardia), there is no loss of consciousness or falling.

The reason for all this should be sought in the larger size of the human brain, and, therefore, the greater consumption of oxygen. This naturally makes the person more vulnerable to reduced blood supply to the periphery.

The non-classical form typical of older people can be considered as real diseasecaused by the process of degeneration of the autonomic nervous system.

Classification

Simple syncope is part of the structure of neurocardiogenic syncope. Taking into account the etiology, they are divided into two variants - typical (emotional, orthostatic) and atypical. The latter are characterized by the absence of triggers and prodromal phenomena, therefore they are sometimes called "malignant". According to hemodynamic parameters, vasomotor syncope is classified as follows:

• Mixed (type 1). The heart rate decreases by more than 10% of the baseline, reaching 40 beats / min or less (but not longer than 10 seconds) without asystole or with cardiac arrest for up to 3 seconds. Bradycardia is preceded by a fall in blood pressure.
• Cardio inhibitory (type 2). The minimum heart rate remains below 40 beats per minute for over 10 seconds. No asystole (type 2A) or lasts more than 3 seconds (type 2B). In the second case, hypotension occurs simultaneously with a decrease in heart rate.
• Vasodepressor (type 3). Loss of consciousness is accompanied by arterial hypotension without severe bradycardia. The drop in heart rate is less than 1/10 of the maximum.

Diagnostics - identifying the cause of fainting

Diagnosis consists in excluding causes not associated with a vasovagal reaction. Of course, the operation is not always simple and, indeed, it is often necessary to use the "protocol" of a long examination, which can be formulated as follows:

• Electrocardiogram. To assess the heart rate.
• Echocardiogram. To evaluate, using ultrasound, the work of the heart valves.
• Holter ECG. In order to shed light on the presence of latent arrhythmias.
• Holter pressure control within 24 hours. To track the course of pressure within 24 hours.
• Standard blood tests. To test for conditions that can cause fainting, it could be anemia or diabetes.
• Encephalogram and MRI of the skull to exclude epilepsy, malformation and vascular problems.
• Tilt test. Practiced in health care, usually in the cardiology department. It consists of lying on a 60 ° tilted bed for 45 minutes. Thus, a vasovagal crisis is provoked. After 20 minutes, if a crisis does not occur, the patient is injected with a drug (nitrate) that lowers the pressure. The test is useful for assessing the causes of fainting.

Symptoms of vasovagal syncope

Vasovagal syncope is a short-term episode of loss of consciousness associated with a sharp expansion of blood vessels and a slowdown in heart rate, in which a person cannot maintain an arbitrary posture. This disease is not life-threatening, but with frequent bouts of loss of consciousness, the quality of life is significantly reduced. According to statistics, they occur in childhood, and over time the nature of the attack does not change.

Vasovagal syncope is accompanied by the following symptoms:

• immediately before loss of consciousness, sweating, nausea, darkening of the eyes, tinnitus occur;
• the skin becomes pale; pulse and pressure are significantly reduced;
• fainting always occurs when a person is in an upright position, and if at the beginning of an attack it is laid horizontally, then the ailment will recede.

Before vasovagal syncope, the following symptoms and signs may appear:

• Pallor of the skin
• Light-headedness
• Tunnel vision: the field of vision is limited, the eye sees only what is in front
• Nausea
• Feeling warm
• Cold clammy sweat
• Yawn
• Blurred vision

People who are near a person during vavovagal syncope may notice the following:

• Abrupt unusual movements
• Slow weak pulse
• Dilated pupils

Recovery from vasovagal syncope begins immediately after unconsciousness and usually takes less than a minute. However, if you try to get up too early after losing consciousness, within 15-30 minutes, there is a risk of fainting again.

general information

In the ICD-10 classification, pathology is noted in section R55 "Syncope". In neurological practice, syncope attacks are more common than other forms of paroxysmal conditions. Paroxysms are not always associated with CNS pathologies. Sometimes somatic diseases play the role of decisive etiological factors.

Vasovagal syncope is a condition that is not usually associated with serious illness or life-threatening. Sometimes occurs in healthy people. It is often associated with the previous psychovegetative syndrome, which is manifested by increased emotionality and anxiety.

The pathogenesis is based on a violation of the neurohumoral regulation of the activity of the cardiovascular system, which in turn is provoked by malfunctions of the autonomic nervous system. The characteristics of vasovagal syncope suggest variability in duration and severity. It can be short-term or long-term, light and deep.

Therapy for vasovagal syncope

If it were not for the danger of injury, then treatment of the problem would not make sense. But given these conditions, treatment is necessary.

There are three types of treatment, namely:

Medication. The drug of choice is midodrine. Therapy is lifelong, although it can be suspended for short periods of time.

Behavioral. Involves some physical maneuvers that should be used when the first symptoms appear. These are isometric contraction exercises that can cause blood pressure to rise during the onset of fainting.

Exercises of three types are used, namely:

• Squeezing the ball. Strong fist clenching, such as a ball. Promotes the outflow of venous blood from the brain.
• Hand tension. Hands are clasped in the lock and pulled in different directions.
• Compression of the legs. Legs are placed crosswise, as shown in the figure, and strained.

Surgical. It includes the installation of a pacemaker that normalizes the heartbeat, which reduces the likelihood of fainting. This treatment is, of course, applied after careful evaluation and only in cases where other remedies fail.

Observation

1. The management of patients with syncope depends on the etiology and treatment.
2. With frequent fainting of unclear etiology, additional examination is required, for example, using an implantable loop ECG recorder, since they can be cardiogenic.
3. With cardiogenic, careful observation is shown, since mortality in these patients is much higher than in syncope of other etiology.

Elderly patients

It is necessary to find out in what conditions the patient lives, since elderly patients with fainting often need constant help around the house. In addition, they pay special attention to the drugs that the patient is taking.

The cardiologist should contact the patient's attending physician and discuss with him the causes of fainting, the prescribed treatment, and when implanting a pacemaker or defibrillator, warn him what to fear and in what cases a specialist consultation is indicated.

Hospitalization

When fainting against a background of heart disease, the prognosis is the least favorable, such patients are hospitalized for examination. Patients without organic heart disease, without ECG changes and with a clinical picture of vasovagal syncope have a generally favorable prognosis, therefore they are usually examined on an outpatient basis. In addition, hospitalization is appropriate for family history of sudden death, physical exertion, and fainting associated with trauma.

Causes of occurrence

Vasovagal syncope is a common cause of transient, sudden, short-term loss of consciousness. Usually occurs during adolescence and early adulthood. The mechanisms of pathogenesis are associated with emotional factors. Usually, the causes of vasovagal fainting are due to experiences and fear provoked by external circumstances - the upcoming dental treatment, blood sampling from a vein, situations of real and imagined danger.

Pathogenesis is based on excessive deposition (accumulation) of blood in the veins located in the lower extremities. The blood accumulated in the veins temporarily does not participate in the general circulation, which leads to a lack of blood supply to certain vascular regions, including parts of the brain. One of the pathogenetic factors is a violation of the reflex influence on the activity of the heart. Causes and mechanism of development of vasovagal syncope state:

1. A sharp decrease in the values \u200b\u200bof the total peripheral vascular resistance (resistance of the vascular walls to blood flow, arising from viscosity, vortex movements of blood flow, friction against the vascular wall).
2. Dilation (expansion) of peripheral vessels.
3. Decrease in the amount of blood that goes to the heart.
4. Decrease in blood pressure indicators.
5. Reflex bradycardia (change in sinus rhythm of the heart, decrease in heart rate - less than 50 beats per minute).

Among the provoking factors, it is worth noting a lack of sleep, physical fatigue, nervous strain, drinking alcohol, an increase in the temperature of the environment or the human body.

Complications

Fainting at altitude, when working with moving machinery, near water or fire creates the risk of serious injury or death. The likelihood of injury increases in old age, especially with concomitant diseases. Syncope conditions in representatives of certain professions (drivers, machinists, pilots) pose a danger not only to the patients themselves, but also to those around them.

Particularly noteworthy are atypical cases with sudden, prolonged loss of consciousness, often recurrent syncope with asystolic pauses.