Fainting: Symptoms and Treatment

Fainting, or syncope, is an attack of short-term loss of consciousness with a violation of muscle tone, the activity of the cardiovascular and respiratory systems. Fainting is not a disease, but merely a symptom of a certain state of the body, and not always the cause is illness. The main mechanism of development of syncope is a sudden decrease in blood supply to the brain. Despite the many causes leading to fainting, his clinical picture is fairly uniform (with small features). In this article, we will talk about what fainting is manifested, about the main types of fainting and their treatment.

Fainting is very common. Almost a third of the world's population suffered syncopation at least once in their lives. The prevalence of syncope increases with age, especially after 65 years (in this age group, the frequency increases by a factor of 2). But the children, on the contrary, very seldom suffer from such conditions.

Why does syncope occur?

The main reason for the onset of syncope is a transient decrease in blood circulation in the brain. As a result, such brain structures as the reticular formation and the cortex of the cerebral hemispheres do not receive enough nutrients and energy. The reticular formation keeps the whole body toned by activating influence on the cerebral cortex and reflex activity. Of all brain structures, it is most sensitive to nutritional deficiencies, so it reacts to a sudden change in the blood flow of the first. Due to dysfunction of the reticular formation, the equilibrium between the sympathetic and parasympathetic parts of the autonomic nervous system with the predominance of the latter is disturbed. The sharp superiority of parasympathetic influences, realized with the help of the vagus nerve, and becomes the cause of all the symptoms of fainting.

Fainting is a very short-term condition, because it is accompanied by a decrease in muscle tone and a fall, as a result of which a person assumes a horizontal position. In this position, the blood flow to the brain is renewed in sufficient quantity, and all symptoms disappear. For the same reason, if you have time to take a horizontal position, when it becomes bad, you can avoid developing fainting.

Symptoms of fainting

The fainting episode is divided into several stages:

• prefind, or lipotymia;
• actually fainting;
• a post-patchy condition.

The lipotymic condition occurs immediately within a few tens of seconds before the loss of consciousness (most often lasts from 4-20 seconds to 1 minutes). At this moment, a person feels a feeling of nausea (dizziness), dizziness, noise or ringing in the ears, blurred vision ("fog "shroud "flies before the eyes"). There is a growing weakness, which rolls like a wave. The legs become "wadded" and unruly, the skin becomes covered with a cold sweat, the face turns pale. In a number of patients, parallel to these symptoms, there is a feeling of anxiety or fear, palpitation, a feeling of lack of air or coma in the throat, numbness of fingertips, tongue, lips, yawn. Sometimes only this can limit the attack, that is, the loss of consciousness itself will not happen, especially if the patient has time to take a horizontal position. In rare cases, syncope occurs without a previous lipolytic condition (eg, with cardiac arrhythmias, fainting swallowing). This stage ends with the sensation of "floating of the soil from under the feet."

The stage of fainting is characterized by a loss of consciousness. Simultaneously with the loss of consciousness, the muscle tone in the whole body is sharply weakened, so patients are more often "slid" to the floor, rather than fall, like tin soldiers. With sudden development of fainting, bruises can occur when falling. Usually, loss of consciousness lasts 5-60 seconds. At the time of lack of consciousness, the skin becomes pale gray, ashy and even greenish, it becomes cold to the touch, arterial pressure drops (systolic index 60 mm Hg and below), the pulse becomes weak, threadlike, breathing surface (can even it seems that the person does not breathe), all deep reflexes fall, the pupils dilate and react poorly to light (that is, they do not narrow as much as fine). If the blood flow in the brain is not restored within 15-20 seconds, it is possible to involuntary urination and defecation, as well as several muscle convulsive twitchings.

Post-syncopal period lasts only a few seconds, until consciousness is fully restored. The resumption of consciousness occurs gradually: as if the vision is activated, the voices of others appear, initially sounding in the distance, the feeling of one's own body returns. These feelings are actually spent a few seconds, but the patient himself remembers them as a slow-motion shot. After complete recovery of consciousness, patients immediately orient themselves in place, time, and self. Of course, the first reaction is fear in connection with what happened. Heart rhythm and breathing quicken, there is fatigue and weakness, sometimes unpleasant sensations in the abdomen and heart. The second period of fainting does not remember the patient, that is, recent memories are associated with a sudden deterioration in well-being.

The severity of syncope is determined by the duration of the period of loss of consciousness and severity of violations of vital functions.

Types of fainting

There is no universally recognized classification of syncope in medicine. One of the most rational, perhaps, is the following classification. So, there are syncope:

• neurogenic;
• somatogenic;
• extreme;
• multifactorial.

Each of these groups is further divided into several varieties.

Neurogenic syncope

Neurogenic syncope is caused by any changes in the nervous system. Among them the most famousreflex(due to the reflex activity of the nervous system). The mechanism of the onset of syncope of this group is as follows: as a result of stimulation of some receptors with Using the reflex arc, the parasympathetic nervous system is activated and the sympathetic nervous system is depressed part. As a result, there is an expansion of the peripheral vessels and a slowing of the heart rate, and also a drop in total peripheral resistance, a drop in blood pressure, and a decrease in cardiac ejection. As a result, blood is deposited in the muscles and is not delivered in the right amount to the brain. This is the most frequent fainting among all species.

The irritation of which parts of the human body can cause a syncope? It can be:

• irritation of carotid sinus receptors (for example, with shaving, in the presence of tumor formation in the carotid sinus region, compression of the neck tightly tied with a tie). The carotid sinus is located at the site of the internal carotid artery from the common carotid artery at the neck at the upper edge of the thyroid cartilage. These faints are called sinocarotid;
• sharp pain (for example, with a ruptured appendix or with renal colic), that is, irritation of pain receptors;
• an attack of cough in the elderly (coughing fainting, or bettolepsy). In older people, a similar mechanism develops fainting after eating, with defecation. The mechanism consists in an increase in intrathoracic pressure during straining, a decrease in the cardiac output and a return of venous blood to the heart from the lower limbs;
• irritation of receptors of internal organs (irrational fainting). For example, when performing a colonoscopy, esophagogastroduodenoscopy;
• irritation of the fibers of the vagus nerve (the main parasympathetic nerve) when swallowing with certain diseases of the esophagus, larynx, mediastinum;
• expressed emotions, which become an irritant stimulus for the autonomic nervous system (with the fainting is the initial hyperreactivity of the autonomic nervous system, that is, in the normal tone of this system, fainting is not arise. Therefore, such faints are often the lot of people with neuroses, neurosis-like conditions, a tendency to hysteria). Fainting is called emotion. For example, the development of fainting when taking blood from hypochondriac persons or receiving extremely unpleasant news.

Neurogenic syncope occurs also:

• discirculatory(arise due to impaired regulation of the vascular tone in neurological diseases: migraine, discirculatory encephalopathy, cerebral vasculitis, and so on);
• maladaptive(develop as a result of a violation of the mechanisms of adaptation of the organism to unfavorable environmental conditions. For example, with overheating, heavy physical exertion);
• associative(develop in situations that resemble past episodes with the development of syncope). Characteristic, so to speak, for creative people with a well-developed imagination;
• orthostatic(associated with a lack of sympathetic influence on the vessels of the lower extremities. In this case, when a person moves from a horizontal position to a vertical position, there is no proper narrowing of the vessels of the lower limbs. Because of this, the increase in arterial pressure necessary for the vertical position of the body does not develop, which means that an insufficient amount of blood enters the upper parts of the trunk and the head). Such fainting can occur when taking diuretics and hypotensive drugs, with blood loss, dehydration.

Somatogenic syncope

These syncope are associated with diseases of other organs and systems (not nervous). They are divided into:

• Cardiogenic (associated with heart disease). Occur as a result of a small ejection of blood from the left ventricle. This can be with cardiac arrhythmias, with aortic narrowing when leaving the left ventricle, and so on;
• hypoglycemic (with a sharp decrease in blood glucose). Such faints often accompany diabetes mellitus, but may also occur in a number of other conditions: hypothalamic insufficiency, congenital intolerance to fructose, starvation, benign and malignant tumors;
• Anemic (with blood diseases with a low content of red blood cells and hemoglobin);
• respiratory (with lung diseases, accompanied by a decrease in the vital capacity of the lungs, with a decrease in the concentration of carbon dioxide in hyperventilation. This is possible with bronchial asthma, emphysema, whooping cough).

Extreme fainting

Extreme fainting occurs in emergencies that require the body to maximize the mobilization of forces. They are divided into:

• hypovolemic (associated with a pronounced deficiency of fluid in the body, for example, with blood loss or staying in hot heat);
• hypoxic (if there is little oxygen in the inhaled air, for example, when staying in the mountains);
• Hyperbaric (with breathing under increased pressure);
• intoxication (the result of poisoning the body, for example, alcohol, dyes or carbon monoxide);
• iatrogenic, or medicamentous (with an overdose of certain drugs: tranquilizers, neuroleptics, diuretics. In principle, any drugs that have the ability to reduce blood pressure can be included in this list).

Multifactorial fainting

This group includes fainting, which occurs as a result of the coincidence of several causative factors. For example, the so-called nicturotic fainting. It occurs predominantly in older men during or immediately after an overnight urination in an upright position. At the same time, the following factors act simultaneously: a decrease in pressure in the bladder leads to an expansion of the blood vessels, which means depositing part of the blood in them; plus to this - a sharp transition from a horizontal position to a vertical position after a dream, and in a dream the influence of the parasympathetic department of the autonomic nervous system. All this "steals" the brain, and a faint occurs.

Diagnostics

Holter monitoring is performed to identify possible rhythm disturbances.

The diagnosis of syncope is made on the basis of the clinical picture and the data of additional methods of investigation. If a syncope was not caused by an extreme cause, then a search for a provoking factor is necessary.

A very important role is played by a detailed description of all phases of fainting by one of the eyewitnesses. Pay attention to the suddenness of the onset, the presence of typical provoking situations, the connection of a syncope with body position, the nature of vegetative manifestations, the presence of concomitant diseases and the intake of medicinal preparations.

Additional methods of research in some cases help to establish the cause of fainting. For example, you may need a daily ECG record (holter monitoring) in order to detect cardiac rhythm disturbances that could be the cause of syncope. A normal ECG for this purpose is not enough. A clinical blood test is required (can detect anemia), a blood test for sugar (a search for diabetes).

To determine the exact cause of neurogenic faints, tests that characterize vegetative reactivity are usually carried out. Most of them, in fact, become a provoking factor for syncope, if its cause is associated with dysfunction of the autonomic nervous system. For example, a sample with ECG monitoring, blood pressure, electroencephalogram for 30 minutes of a passive vertical position with a sharp translation into the horizontal, and then again in the vertical (provocation of changes in orthostasis); or a sample with a carotid sinus massage; or a test with frequent and deep breathing, which provokes hyperventilation.

Differential diagnosis between syncope and epileptic, convulsive seizures is very important. It must be performed with the help of electroencephalography, which allows to detect the pathological activity of the brain in epilepsy.

Treatment

Treatment of a syncope directly depends on its cause (that is why such attention is paid to the diagnosis not of the fact of fainting, but of its origins). About emergency care at the time of syncope you can learn from the same article. Here we will focus on methods for preventing syncope.

Extreme faints do not require, as such, the treatment of fainting themselves, since they disappear on their own during the elimination of an emergency.

Somatogenic syncope requires treatment of the underlying disease. For example, if cardiac arrhythmia is detected, an antiarrhythmic drug should be prescribed by a cardiologist to normalize the cardiac rhythm or in detecting iron deficiency anemia, iron-containing preparations are required to correct hemoglobin and the amount erythrocytes.

In the treatment of neurogenic syncope, non-drug and medicament measures are used. They need patients with repeated fainting. The study of different groups of drugs for the treatment of syncope showed inconsistent results, that is, in some cases, it gave an effect, in others it did not. Therefore, to date, physical measures to prevent syncope are considered paramount (this rule only works with neurogenic fainting (!), Except dyscirculatory ones). Simply put, patients are taught to avoid situations that provoke neurogenic syncope, and take measures to prevent unconsciousness with an approaching syncope.

Among physical measures, actions such as crossing the legs and squeezing the hand into a fist with approaching fainting are used. This may seem silly, but these measures have proven effective in research. The bottom line is that performing such simple physical actions causes an increase in blood pressure, sufficient to prevent fainting or at least delay it (for example, before sitting down or lie down). People with frequent orthostatic fainting can benefit from daily orthostatic training. However, in order for this to work, long training is necessary.

It is necessary to avoid the factors provoking neurogenic syncope: staying in a stuffy room, abruptly rising from the bed, wearing tightly tied ties and so on. Attorneys should not watch for medical manipulation (blood sampling and the like).To reduce the deposition of blood in the lower limbs with orthostatic fainting (especially the elderly) it is recommended to use compression knitwear or tightly bandage the lower extremities.

From medications, β-adrenoblockers (Atenolol, Metoprolol, Propranolol), mineralocorticoid Fludrocortisone and α-adrenomimetic Midodrin can be used. If one drug is ineffective, you can try a combination of the two.

It should be borne in mind that neurogenic faints often develop against a background of vegetative dystonia syndrome, so the correction of psycho-vegetative disorders can lead to the disappearance of syncope. The volume and nature of treatment in this case are determined individually.

In general, it should be said that the methods of treating syncope are ambiguous, so continue to be studied.

Thus, fainting is a paroxysmal change in consciousness with a transient disruption of the vital functions of respiration and cardiac activity. Fainting is not always a manifestation of diseases of the nervous system. Repeated fainting significantly affects the quality of life of the patient. To help the patient get rid of the disease, it is necessary to establish the cause of the development of syncope, as this plays a key role in choosing a method of treatment. Reliable methods of treatment of syncope are under development, sometimes only preventive measures are effective.

Doctor Komarovsky, the program "Emergency Care" on the topic "Loss of consciousness (fainting)

Loss of consciousness (fainting) - Doctor Komarovsky - Emergency Care

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