Internal Medicine

Fainting (syncope)

Synonyms in a broader sense

Fainting
unconsciousness
blackout
collapse
collapse

English: swoon, faint

Summary

The term "syncope / Faint“Describes a sudden onset of loss of consciousness due to a momentary undersupply of the Brain with blood.
The causes of fainting are many and varied, ranging from harmless to life-threatening, and may give rise to an extensive diagnostic investigation.

definition

A faint (syncope) is a short-term loss of consciousness caused by a cerebral blood flow that is not adapted to the current state of activity. The supporting and holding muscles of the affected person lose tension, which can lead to falls. After restoration of an adequate blood flow in the brain, unconsciousness ends automatically. Also read: Circulatory disorders

frequency

The frequency of fainting spells is increasing with 0,7% per year, the most common cause is malregulation of the autonomic nervous system (vegetative or vasovagal syncope).

Info: vegetative nervous system

The vegetative nervous system controls and regulates the activity of our internal organs and glands and sensibly coordinates all vital and mostly unconscious processes, e.g. the regulation of:

Digestion of food
Level of blood pressure
breathing or
of reproduction

This nervous system is autonomous because these processes escape our arbitrary control and are subject to their own laws.
See also: sympathetic, parasympathetic

causes

Cause for a Faint (syncope) can be all states of the body in which there is a sudden onset of decreased cerebral blood flow and thus an undersupply of oxygen and nutrients. These include, broken down according to organ systems:

heart: Reduced delivery rate due to e.g. B. a Heart attack, Cardiac arrhythmias, Heart muscle diseases, Pulmonary embolism, Pericardial effusion, narrowing of the outflow channels in lung and body u. a.
brain: Local flow obstacles z. B. in the context of calcification of the cerebral vessels, stroke and preliminary stages, increased intracranial pressure, rarely also tapping syndromes in which the blood supply required in other parts of the body is diverted from the brain.
Cycle: „orthostatic dysregulation“(A slower adaptation of heart rate and blood pressure when changing position lying / sitting / standing), low blood pressure, reduced blood return to the heart, e.g. B. by stool / urinary pressure (increased pressure in the chest throttles the return flow to the heart) or in pregnant women by the pressure of the uterus on the lower Vena cava in the supine position; Blood loss.
Autonomic Nervous System: vegetative syncope
Medication: V. a. Antihypertensive drugs can cause fainting if the “attitude” is too strict.

Short-term fainting / unconsciousness can also be caused by other disease mechanisms that should be excluded diagnostically. These include B. Metabolic imbalances like Hypoglycaemia, epileptic seizures, Poisoning, derailment of the mineral balance, etc.

Symptoms of fainting

As a sign of an impending collapse (fainting) you can dizziness, Pallor, tremors, colder Sweat, Flicker or blackening in your eyes, or ringing in your ears.
In the fainting spell, those affected lose consciousness and can sink to the ground. Jerks and occur rarely cramps on the limbs while fainting. Accompanying symptoms of the cause of the collapse can occur (e.g. chest tightness in a heart attack, a headache at Cerebral hemorrhage, Failure symptoms in stroke).

Pretend to faint

A Faint can be faked to a certain extent.
You look for a suitable place that is not too busy and initially pretend to be slightly uncomfortable: the walk slows down, the conversation falls silent and overall you appear tired and weak. This all happens slowly, at the same time you hold your head against the alleged one a headache and take a deep breath in and out of the simulated vertigo. After informing other people about the discomfort, you look for fresh air.
The real "faint“Is probably the hardest part as you should fall safely and don't want to injure yourself further. Since fainting is equated with a loss of control, the pretender will close his eyes and relax the muscles and in retrospect will indicate that he has amnesia, i.e. not knowing anything about what happened before.

However, it is important to be able to differentiate when someone is just pretending and when someone is actually passed out. In the case of a slight faint, it helps to wake the unconscious person with a pat on the cheek.
A simple decision aid is that Reflexes to consider.
If the patient is actually passed out, these are reduced or no longer there. A simple reflex is triggered by stroking the eyelashes: the closed eye winks or is pinched in a patient who is not really passed out. Or you take an arm and let it fall. A simulant will not let the arm drop completely limp on the floor. It is important in any case - whether faked or not - to take the fainting seriously and to check whether the unconscious patient is still breathing. This has to be done to rule out the possibility of the patient having an acute one Cardiovascular failure suffers and reanimated must become.

Diagnosis

Basic measures of fainting - diagnosis are the physical examination, pulse and blood pressure measurement while lying down and standing and checking the blood values, the first indications of an underlying circulatory or metabolic disorder such as B. low blood pressure, or anemia diabetes can give.
Further measures can be taken by the Heart for example EKG examinations to be possible Cardiac arrhythmias to uncover or a Ultrasound examination of the heart that u. a. Gives clues to the pumping function of the heart. If there is a corresponding suspicion, the search for circulatory disorders in the brain through a representation of the brain supplying Arteries be justified or a Brain wave measurement (EEG) to exclude Epilepsies.

therapy

As each Faint An emergency doctor should be called. Since protective reflexes fail in unconscious patients and muscle tension decreases, there is a risk that your own tongue will sink back and obstruct the airways or vomit will get into the airways. Therefore, until the doctor arrives, the breathing and pulse of an unconscious person must be checked at short intervals and the patient must go to the stable side position (see there).

With a classic vegetative syncope (Fainting) such complications are very unlikely due to their short duration.

One cannot generally recommend keeping the legs of the unconscious up high, because with some causes of a collapse the initial condition of the patient can even worsen.
While at simple collapse due to emotional stress or exhaustion this is correct and would help the patient, would in a patient who due to a sudden overload of the Heart (e.g. as part of a Heart attack) has collapsed, exacerbate the overload caused by the blood flowing back from the legs. The therapy is based on the (suspected) cause of the breakdown - both acute and long-term.

If the Faint finished, can homeopathic or Bach flowers Emergency drops then help to improve the situation. Read more about this in our topic: Homeopathy for circulatory collapse

Fainting during pregnancy

Fainting is caused by too little oxygen reaching the brain from the blood.
The blood supply in the whole body is changed, especially during pregnancy, since the maternal circulation also supplies the unborn child to a certain extent.
In addition, the way back to the heart is made more difficult for the blood as the child grows and displaces the organs in the abdomen. The fainting during pregnancy is triggered when the child not only displaces the organs but the uterus presses on the inferior vena cava (Inferior vena cava) and thereby the blood supply to the heart is significantly reduced or depressed. This happens especially in late pregnancy (last trimester) when the child is already big.

This clinical picture is called vena cava compression syndrome. Vena cava compression syndrome is characterized by an abrupt drop in blood pressure. As a result of the compression, less blood flows back to the heart, so there is a lack of blood volume, which means that less oxygen reaches the brain. This leads to fainting.
The fainting spells mainly occur when the pregnant woman lies on her back, since the vena cava runs to the right of the spine and the uterus lies directly on it when the woman is lying on her back. If a fainting spell occurs during pregnancy, the patient should be brought to the left side as quickly as possible so that the vena cava is relieved and the blood continues to circulate. Because blood circulation is very important not only for the life of the mother, but also for the life of the child.
In the event of insufficient supply, premature birth can be triggered. To prevent fainting during pregnancy, it is advisable not to lie on your back for long and take the left side position.

Read more on the topic: Pregnancy complications and vena cava compression syndrome

Fainting in children

The causes of fainting in children are numerous, but always requires prompt action.
Some fainting cases can be resolved without the help of a doctor, while others require the help of a doctor. The child should always be in the stable side position be stored.

In young children, unconsciousness is often caused by a "Emotional spasm“Triggered. This is caused by long screaming when angry or frustrated. In this case the child will come to on its own very quickly. Another case is fainting if the child got up quickly or was frightened.
This fainting is caused by blood pressure being too low (Orthostasis Syndrome) and also occurs frequently in young girls in the puberty on. Fainting can also be caused by hyperventilation.
Hyperventilation can be recognized by the fact that the children are breathing noticeably fast. The body then receives too little oxygen and, at the same time, carbon dioxide accumulates due to insufficient exhalation. In the last two cases mentioned, the children should first be placed on their backs and the legs raised until the children regain consciousness.
If the child remains unconscious, the stable side position should be assumed and an emergency doctor should be called in. If such cases of fainting occur frequently, an appointment should be made with the responsible pediatrician to clarify the reasons and to find a way to prevent this. Another reason related to fainting spells in childhood Diabetes mellitus can a Hypoglycaemia which can be recognized by the fact that the skin is warm and moist.
In this case you should always call the emergency doctor and bring the child into the stable side position.

Other types of fainting are always an emergency and therefore need to be clarified by an emergency doctor. There are many possible causes:

Poisoning
Brain inflammation
Cardiac arrhythmias and many more.

If you fail to breathe, start the resuscitation. Since breathing is often the reason for cardiac arrest in children, the intervals between cardiac massage are shorter (15 times) and then two respirations follow.