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Syncope – Losing Consciousness

17January 2014

SYNCOPELosing consciousness is a terrible feeling for any human being. If somebody loses consciousness for a brief period of time and recovers without paralysis of any limb then it is called syncope in medical terms. There are several medical causes of this phenomenon starting from electrical block in our heart circuit to valve narrowing. Whatever be the cause, it has to be taken seriously by patients , their families as well as by the doctor. There is a common misbelief that ‘gas ‘ is the cause of this kind of symptom. Gastric causes can never be the reason for this kind of symptom. Syncope due to heart block is repetitive and can happen anywhere at any time. This may come with head injury even deaths due to motor vehicle accidents. Many of these are totally reversible and preventible .  Awarenes s is the most important thing. Before g0ing into evaluation of causes i would like to highlight a few first aid remedies for this .

When somebody loses consciousness then his eye balls move upward, he passes urine or stool in his clothes and falls on the ground. One should lie down on the ground or on a flat surface . Both legs should be elevated and the head end of the bed should be lowered down . Chest compression should be started at a rate of 50 to 60 counts per minute and if possible mouth to moth breathing over a handkerchief should follow. The patient’s mouth should be turned to one side so that one does not aspirate the food content or vomits in the air pipe thereby leading to choking. The best thing to do is check the pulse in the patient’s neck or listen to his heart through your naked ear; ECG is the next thing to do which is a basic step before asking for special tests which include tests like Holter CT or MRI scan of brain angiography of heart, etc.

The treatment of cardiac syncope 

In Obstructive lesions such as valvular heart disease, obstructed blood vessels, or cardiac tumors , as a general rule surgery is imperative, whatever the risks involved.

Heart rhythm disturbances that produce syncope fall into two broad categories: bradycardia and tachycardia.

Bradycardia, cardiac arrhythmias that produce a slow heart rate, can cause syncope when the heart rate becomes so slow that insufficient blood is pumped to the brain, and consciousness can no longer be maintained. Fortunately, implanting a cardiac pacemaker can easily treat this problem.

Tachycardias are heart rhythm disturbances in which too many electrical impulses are produced by the heart, thus causing the heart to beat too rapidly. While there are many kinds of tachycardia, only two produce syncope with any regularity – ventricular tachycardia (VT) and ventricular fibrillation (VF).

One treatment used for both VT and VF is antiarrhythmic drugs. These drugs, as a class, tend to be quite toxic, and their effectiveness in completely eliminating VT and VF is relatively poor. Therefore, antiarrhythmic drugs should be used only rarely as the primary treatment for patients whose VT or VF has produced syncope.

A second form of treatment is ablation. Ablation consists of carefully mapping the electrical system of the heart (either in the electrophysiology laboratory or in the operating room), locating the part of the electrical system that is causing the arrhythmia, and ablating the offending area (by freezing it, burning it, or surgically excising it). Unfortunately, most forms of VT are very difficult to localize to a specific “culprit” area. This means that ablation is only infrequently an option for VT (and never for VF).

The third and most effective treatment for both VT and VF is the insertion of an implantable defibrillator(which gives internal shock to the heart directly). In nearly 20 years of clinical use, the implantable defibrillator has proven itself to be extraordinarily effective in automatically stopping lethal tachycardias, and preventing sudden death. Because of the remarkable effectiveness of the implantable defibrillator (and the disturbing ineffectiveness of other methods of therapy), this device is, by far, the best choice for patients who have had VT or VF that has produced syncope.

Usually pacemaker is either a single chamber or a double chamber depending on its potential to stimulate one ventricular chamber or both atrial and ventricular chamber in synchronized fashion. Though the cost becomes double in dual chamber , it gives certain advantage over single chamber like preservation of pumping function, prevention of clot formation in heart, and enlargements.

Constant follow up of a pacemaker by a doctor improves the battery life of a pacemaker; at the end of the life of pacemaker a new battery is replaced free of cost by the pacemaker company.

All pacemaker surgeries are done using local anaesthesia in the operation theatre under x ray control. Usually one to two hours are required for the whole procedure. Complications are almost nil in expert hands.

 

Posted in cardiac  |  3 Comments

3 Responses to Syncope – Losing Consciousness

  1. Rahul Gupta says:

    Sir another way of a evaluation could be external or internal loop recorder to rule out cardiac syncope. what do you say about this.

  2. sgroclkc says:

    There are two main types of scary phenomenons in sleep(nightmare and sleep paralysis) that are caused by two main scary symptoms of cardiovascular disease {palpitation and fainting (syncope)}.

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Dr. P. K. Hazra

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