Syncope is defined as a transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness.

Although most causes of syncope are benign, this symptom presages a life-threatening event in a small subset of patients.

Classification of Syncope

Reflex syncope may be due to vasovagal syncope, which is mediated by emotional distress such as fear or physical pain.

Situational syncope describes syncope that occurs with a fixed event such as micturition, deglutition, exercise induced, and carotid sinus syncope.

Vasovagal syncope is the most common type in young adults but can occur at any age.
It usually occurs in a standing position and is precipitated by fear, emotional stress, or pain (eg, after a needlestick).

Age / Sex group affected by Syncope

Syncope occurs in all ages .

Various studies suggest categorizing patients older than 45 years, 65 years, and 80 years as “higher risk.”

No clinically significant difference between male and female .

Races affected by Syncope

No significant differences regarding race are observed

Causes of Syncope

A syncope can be due to vascular disease , arrhythmia or valvular dysfuntioning .
Patient with ventricular arrhythmia
Supraventricular tachyarrhythmias include supraventricular tachycardia and atrial fibrillation with rapid response. These may be associated with palpitations, chest pain, or dyspnea.
Cardiac outflow obstruction may also result in sudden-onset syncope with little or no prodrome.
Syncope can also result from an acute MI, acute aortic dissection, and pulmonary embolus.

These conditions can have associated chest pain, neck pain, shoulder pain, dyspnea, epigastric pain, hypotension, alteration of mental status and can result in sudden death.

Bradyarrhythmias include sick sinus syndrome, sinus bradycardia, high-grade atrioventricular blocks, pacemaker malfunction, and adverse medication reactions.

Syncope Signs and Symptoms

Faintness, dizziness, or light-headedness occurs in majority of patients experiencing true syncope.
Other symptoms are vertigo, weakness, diaphoresis, epigastric discomfort, nausea, blurred, pallor, or paresthesias.
• Headaches
• Low back pain , palpitations , chest pain
• Loss of consciousness

Investigations of Syncope

History and physical examination are the most specific ways to evaluate syncope.
Syncope may occur at rest; with change of posture; on exertion; after exertion; or with specific situations such as shaving, coughing, voiding, or prolonged standing.

A detailed neurologic examination assists in establishing a baseline as well as defining new or worsening deficits.
The patient must be examined for signs of trauma. Trauma may be sustained secondary to syncope with resultant head injury, lacerations, and extremity fractures.
• Chest radiography
• Brain MRI
• Electrocardiography
• Stress test

Differential diagnosis of Syncope

• Aortic stenosis
• Cardiomyopathy
• Heart block
• Hypoglycemia
• Mitral stenosis
• Pulmonary embolism

Treatment of Syncope

Prehospital management of syncope includes –
• Oxygen administration
• Advanced airway techniques
• Glucose administration

• Medicines: There is no special medicine used to treat syncope.

• Increase liquids and salt: drinking more liquids to prevent dehydration. You may need to increase your salt intake to keep your blood pressure from dropping too low and causing syncope.

Homeopathic treatment for Syncope

Arsenic album –
• Drowsiness, sleeping sickness
• Great fear with cold sweat
• Great exhaustion after slight exertion
• Restlessness, low vitality

Lachesis –
• Delirium tremens with trembling and exhaustion
• Sensation of tension in various parts
• Palpitations, fainting spells
• Cyanosis

Secale –
• Dysnea and oppression
• Palpitations
• Intermittent pulse
• Debility , anxiety , emaciation

Ginseng –
• Vertigo
• Difficulty in opening eyes
• Semi-lateral headache

Diet / management of Syncope

• In case of feeling dizzy, sit or lie down right away. Put your feet up higher than your head. This will get the blood flowing back to your heart and brain.
• Moving slowly. This is very important when you change from a lying or sitting position to a standing position.
• Take some deep breaths before you stand up from a lying position.
• Straining to have a bowel movement may cause you to faint. Walking is the best way to get your bowels moving. Eat foods high in fiber to make it easier to have a bowel movement. Good examples are high-fiber cereals, beans, vegetables, and whole-grain breads.
• Do not drive a car
• Do not exercise outside during the heat of the day.

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