Understanding Syncope In Seniors | Lakeside At Mallard Landing

Fainting episodes can occur at any age, although it is more likely in older adults due to their existing health conditions and deteriorating physical state. When the blood supply to the brain is diminished or interrupted, this results in syncope, often known as fainting. Before you send yourself or your loved ones off to a retirement community, you should understand syncope and the risks it poses.

Causes of Syncope

When there is a reduction in blood pressure, there is a lack of blood supply to the brain. This is known as vasovagal syncope and is one of the most common causes of syncope in older adults. It can happen even with minor actions, such as sitting for an extended period of time and then standing up rapidly. This causes the blood to settle in the lower half of your body due to the lengthy amount of sitting. To keep the blood flowing up to your brain, your heart has to work a little harder. However, as you become older, this becomes more difficult and might result in dizzy spells.

Other causes of vasovagal syncope in adults include witnessing blood or having blood drawn, standing for extended periods of time, exposure to heat, anxiety, and dehydration. The most prevalent causes of syncope are neurally-mediated, such as vasovagal syncope and orthostasis. While less prevalent causes of syncope, such as cardiac structural disease and arrhythmia, have worse results than neurally-mediated and orthostatic causes.

Symptoms of Syncope

Knowing what causes syncope in older adults might help you be more observant and avoid factors that may cause you to collapse. However, because this is not always possible, it is necessary to be aware of symptoms that suggest you may pass out. Feeling lightheaded, tunnel vision, nausea, impaired vision, or a cold, clammy sweat are among some of the common symptoms.

Can Syncope Be Treated?

There is no actual syncope remedy; instead, concentrate on managing the symptoms. While syncope is normally safe, the danger rests in what happens around you when you are about to faint. You would not want to bang your head when you fall or have a fainting spell at the top of the stairs, for example. Your doctor may order certain tests to see whether the fainting spells are a sign of a more serious cardiovascular issue, such as cardiomyopathy. It is critical to be aware of the illness and to recognize when an episode is approaching so that you can remain safe.

What to Do if Someone Faints?

Seek emergency medical attention if an older adult loses consciousness, especially if they have cardiac issues, are prone to fainting spells, or have lost their consciousness and fell as a result of syncope. If you are able to get involved, there are several actions that you do to ensure their safety before the relevant authorities arrive. When someone has fainted but is continuing to breathe, try to lay them on their back, with their feet about a foot above their heart. This will help to restore and improve blood flow to your loved one’s brain.

When should you worry about fainting?

Don’t try to diagnose yourself; seek immediate medical attention if you lose consciousness.

Fainting can be alarming, and it should be. While often the cause of fainting is something minor, fainting also can be a sign of a serious underlying medical concern. “The problem is that you can’t evaluate yourself, and you should let a physician determine if fainting is worrisome or not,” says Dr. Shamai Grossman, an associate professor of emergency medicine at Harvard Medical School, who has conducted 20 studies on fainting.

Serious causes

Fainting usually is caused by a temporary drop in blood pressure. During that brief drop, the brain does not get the blood flow that it needs—and you lose consciousness. One serious cause of this drop in blood pressure is bleeding, such as in the stomach or intestines, or from a rupture of the body’s main artery, the aorta.

Several different heart problems also can temporarily lower blood pressure. One is heart block, in which the heart beats too slowly to pump enough blood. An irregular rhythm of the heart’s main pumping chambers, the ventricles, can cause the heart to pump blood less efficiently. Abnormalities of a heart valve, particularly a stiffening of the aortic valve, also can cause a temporary loss in pressure.

All of these heart problems often produce symptoms such as palpitations (a feeling like your heart is skipping a beat or racing), shortness of breath, or chest tightness. If you have any of these symptoms, it is urgent that you get to the hospital.

Another serious cause of a sudden loss of consciousness is a seizure, which is an abnormality of the brain, not related to blood pressure. Some seizures produce dramatic shaking movements and loss of consciousness for longer than most fainting spells. However, other seizures can be more subtle and hard to recognize as seizures.

Minor causes

Sometimes fainting is caused by stimulation of the vagus nerve, which can briefly lower both heart rate and blood pressure. The condition is called vasovagal syncope (SIN-cope-ee). It can occur if you strain while having a bowel movement (or, for men, while passing urine), have blood drawn, get an injection, hear bad news, or even laugh too hard. These kinds of fainting episodes commonly affect young people but can occur in older adults. Just before a person faints from vasovagal syncope, he or she often feels nauseated or breaks out in a cold sweat.

You may lose consciousness for just a moment if your blood pressure drops when you stand, a condition called orthostatic hypotension. Gravity temporarily pulls blood down into the veins of your legs and feet. This reduces the amount of blood that returns to the heart and which thereafter can be pumped to your brain. Medications, especially blood pressure drugs, often cause orthostatic hypotension. So can dehydration, thyroid disorders, and neurological conditions such as Parkinson’s disease.

Going to the hospital

When you arrive at the hospital, clinicians will check your blood pressure and ask what medications you’re taking. They may draw blood or perform an electrocardiogram to check for irregular heartbeats. The cause of your fainting may be evident immediately. Other times, it will require more testing. Young adults with symptoms indicating vasovagal syncope often are not hospitalized. However, patients ages 50 and older in the United States often are admitted for testing, because the serious causes of fainting become more common in older people. Despite hospitalization and testing, sometimes the cause of fainting is never determined.

What you should do

The bottom line is that you need medical evaluation if you faint—or if you feel repeatedly as if you are about to faint. Note carefully any symptoms you remember before or after you pass out. Ask anyone who may have seen you faint describe to you what they saw. All of this information will help the doctor help you.

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Loss of consciousness or fainting. Causes.

Fainting
Arrhythmia
Neurology

Content:

• What is fainting?
• What are fainting spells?
• How common is syncope in adults?
• What are the symptoms?
• What are the dangers of fainting?
• What is the first aid for fainting?
• When is it necessary to undergo a medical examination after fainting?
• What should be the examination of a patient who has experienced a short-term loss of consciousness?

What is fainting?

Fainting (or syncope) is a sudden short-term loss of consciousness that occurs due to a sharp decrease in blood flow in the brain and is accompanied by the disappearance of muscle tone, and, consequently, the fall of a person. Disabling consciousness during fainting is seconds (less often – minutes).

What are fainting spells?

• Reflex vasovagal, considered the most common, that occurs with prolonged standing, exposure to fear, pain, medical manipulations
• Reflex situational on urination, swallowing, defecation, coughing, sneezing, laughing, playing wind instruments, after exercise
• Reflex syncope of the carotid sinus caused by compression of the neck (for example, during shaving) or tilting of the head
• Syncope due to orthostatic hypotension (on rising quickly from a lying position)
• Cardiogenic (or cardiovascular) caused by organic disease of the heart or large vessels (eg, arrhythmias, aortic valve disease, tumor in the heart cavity, congenital heart disease, pulmonary embolism)

The basis of any syncope is a short-term decrease in blood flow to the brain. There are a number of short-term (seconds-minutes) or relatively long-term (minutes-hours) options for turning off consciousness, which by their nature are not fainting, although they may have a certain similarity with them. These conditions include epilepsy, hypoglycemia, various poisonings with toxic substances, cerebral hemorrhage, and others.

Often there are so-called. psychogenic (or hysterical) “fainting” – disorders without actual loss of consciousness, but reminiscent of a real syncope.

In everyday clinical practice, among the causes of short-term loss of consciousness, two-thirds of all cases (approximately 70%) are reflex syncope. The share of other variants of transient loss of consciousness, which can be established during the examination, accounts for 10-15%, and in another 15-20% of cases, the cause of the loss of consciousness cannot be found out despite the comprehensive examination.

How common is syncope in adults?

Syncope is fairly common in the general population. It is estimated that approximately 30-50% of adults can recall at least one episode of transient confusion during their lifetime that can be interpreted as syncope. The prevalence of syncope confirmed by medical attention is approximately 10 per 1000 people. The maximum occurrence of the first syncope in life corresponds to the age interval of 10-30 years, the minimum – 50 years. In young and middle age, women are more likely to suffer from reflex, but less often cardiogenic syncope compared to men, in old age such differences are leveled. In 15% of cases, syncope has a recurrent course. In 10-15% of people suffering from reflex syncope, a hereditary predisposition can be traced.

What are the symptoms?

In rare cases, syncope develops almost suddenly, in most others, a few seconds or minutes before the onset of syncope, a variety of symptoms can be observed: unsteadiness in standing position, dizziness, slowness of thought, visual disturbances (narrowing or loss of visual fields, impaired color perception, veil before the eyes ), severe general weakness, ringing in the ears, feeling of lightheadedness, nausea, discomfort in the abdomen, sweating, pale skin, palpitations, rapid breathing, yawning.

During the period of the actual syncopal state of a reflex nature, consciousness is absent from 5 seconds to 4-5 minutes (in most cases, no more than 30 seconds). Muscle tone, which ensures the maintenance of the posture, gradually decreases until it is completely lost, as a result of which the patient slowly falls, as if settling. During fainting, patients do not come into contact and do not react to external stimuli. Pallor of the skin, local or general sweating, rare breathing, low blood pressure are noted. The pulse becomes thready and disappears. During fainting, the eyes may remain open. Occasionally, there is a violation of the functions of the pelvic organs by the type of involuntary urination or defecation. Fainting lasting more than 20-30 seconds in some cases is accompanied by short-term clonic convulsions (twitches).

Recovery of consciousness, orientation and postural tone occurs quickly (sometimes almost immediately), but patients may experience general weakness, headache, dizziness, dry mouth, anxiety, especially if fainting occurs for the first time in life.

Why are syncope dangerous?

Falling during fainting may be accompanied by injury, and sometimes death (especially in persons of certain dangerous professions – rock climbers, high-altitude workers, etc. ). Repetitive fainting can affect the professional and domestic components of life, the quality of life of a person. Since in some cases fainting is a sign of an existing heart disease, this usually indicates the seriousness of its consequences for life. Fainting occurring in certain professions (pilots, drivers, operators) can pose a threat to public health.

What is the first aid for fainting?

In typical reflex syncope (for example, due to prolonged standing), the patient should be placed in a cool place with fresh air, if possible, loosen tight clothing or squeezing accessories (tie, collar, belt, corset), give the legs an elevated position. Application of painful stimuli (patting on the cheeks) is usually not required, since the patient quickly regains consciousness on his own. In prolonged cases, the return of consciousness can be accelerated by bringing cotton wool with ammonia to the nose or tickling the nasal mucosa. In the vast majority of cases, individuals who seek medical attention after experiencing vasovagal syncope need mainly reassurance and awareness of the nature of these conditions.

When is it necessary to undergo a medical examination after fainting?

• If fainting causes injury
• If syncope did not occur for the first time
• If the blackout occurred after a strong heartbeat, chest pain, shortness of breath, abdominal pain or severe headache
• If syncope occurs during physical exertion or while lying down
• If the blackout occurred suddenly without warning (weakness, dizziness, blackouts, etc.)
• If known cases of sudden death in close blood relatives at a young age
• If the patient is known to have organic heart disease (eg, prior myocardial infarction, heart disease, cardiomyopathy, or any arrhythmias) or other serious disease (eg, anemia, diabetes, peptic ulcer, cancer)
• If fainting occurs in persons of special professions (injury or responsible for the safety of others)

What should be the examination of a patient who has suffered a short-term loss of consciousness?

In most cases, to understand the nature of the episode of short-term loss of consciousness, it is enough to carry out several routine diagnostic techniques:

• Detailed history taking, including interviews with eyewitnesses of loss of consciousness
• Examination by a cardiologist (general practitioner)
• Standard electrocardiography (ECG)
• Cardiac ultrasound (echocardiography)
• General clinical and biochemical blood tests (glucose, electrolytes (potassium, sodium), troponin, N-terminal precursor of brain natriuretic peptide (NT-proBNP), D-dimer)
• Neurological examination

In cases where the problem of the completed blackout requires additional analysis, it is necessary to consider the possibility of using other specialized diagnostic methods:

• Continuous ECG monitoring (24-72 hours)
• Heart rate monitoring with a portable device implanted under the skin
• Ambulatory blood pressure monitoring
• Tilt test or prolonged passive orthostasis test (45 minutes in an almost vertical (60⁰-70⁰) position on a special turntable)
• Tests with metered exercise on a bicycle ergometer or treadmill
• Stress echocardiography with exercise or certain drugs
• Intracardiac electrophysiological examination
• Coronary angiography
• Magnetic resonance imaging of the heart
• Video recording of syncope as such
• Electroencephalography
• Magnetic resonance imaging of the head
• Duplex scanning of arteries of the neck
• Angiography of the main arteries of the head
• Consultation of a psychiatrist or psychotherapist

It is advisable to carry out the initial assessment of the episode of short-term loss of consciousness in the treatment and diagnostic centers of the cardiological profile, which is due to several reasons. First, most reflex syncope is accompanied by a marked drop in blood pressure and / or a sharp decrease in heart rate up to asystole. Second, the most life-threatening syncope occurs in people with serious heart disease. An in-depth examination should be carried out in centers that specialize in diagnosing syncopal conditions and have the necessary laboratory and instrumental capabilities.

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The author of the article

Anton Barsukov
Vladimirovich

Deputy chief physician, professor

Work experience: since 1994

More details

Fainting: causes and signs of loss of consciousness, first aid

Fainting is a short-term loss of consciousness due to a sudden decrease in blood flow to the brain.

Fainting lasts from a few seconds to several minutes, deep fainting – up to half an hour. Harbingers of fainting (pre-syncope): weakness, dizziness, increased sweating (“sticky” sweat), pallor of the skin, discomfort in the chest and abdomen, nausea, changes in heart rate, respiration and blood pressure, impaired coordination.

Syncope occurs in all age groups but is most common in the elderly.

Causes of fainting

Vasovagal (simple) syncope – a short-term loss of consciousness caused by a sharp drop in blood pressure due to impaired neuromuscular reflexes (excessive vagal tone) – usually has an easily determined cause: emotional stress, trauma, pain, fear, intolerance to the type of blood, hypoxia due to being in a stuffy room, strenuous physical activity in hot weather, standing for a long time, rising quickly to an upright position from a lying position, rapid and deep breathing (hyperventilation), sudden drop in blood pressure due to bleeding or severe dehydration.

Carotid sinus syncope is associated with accidental compression of the carotid sinus (an enlarged part of the arterial bed of the carotid artery): occurs with a sharp turn of the head, wearing a tight collar or tie.

Situational syncope occurs in certain situations: sneezing, coughing, lifting heavy objects, urinating or defecation, swallowing.

Syncope can also be caused by medical conditions (cardiovascular disease, diabetes, anxiety disorders) and certain medications. For example, diuretics, calcium antagonists, ACE inhibitors, nitrates, antipsychotics, antihistamines, and the drug for Parkinson’s disease (levodopa) are associated with an increased risk of fainting. In addition, the risk of fainting is higher in people who abuse alcohol or use psychoactive substances. Syncope is not usually the primary sign of a neurological disorder, but may indicate an increased risk of such a disease (Parkinson’s disease, postural orthostatic tachycardia syndrome, diabetic and other types of neuropathy).

When should I see a doctor in case of fainting?

A one-time loss of consciousness, which happened for an understandable reason, does not require a visit to a doctor. If fainting recurs, provided that there is a history of serious illness, and the person is taking medication, specialist help is needed. This is especially important if there are cardiovascular diseases, arterial hypertension, diabetes. It is also necessary to consult a doctor if arrhythmia, chest pain, shortness of breath, impaired vision, speech, confusion were noted before or after loss of consciousness; fainting during pregnancy, sudden fainting without a specific cause, fainting that occurs more than once a month; convulsions with fainting, loss of bladder or bowel control.

A person who has lost consciousness can be helped (until the ambulance arrives) as follows: check if his airway is clear, if he is breathing (if not, start cardiopulmonary resuscitation before the ambulance arrives), provide fresh air, free from tight clothes, raise the lower limbs above the level of the heart, about 30 cm, if the person has vomited, turn him over on his side to prevent suffocation, make sure that he does not get up for 10-15 minutes, if this is not possible, sit him down, lean forward so that the shoulders touch the knees.

If a person knows under what circumstances he can faint, what triggers affect it, he can try to prevent it: do not get up suddenly from a prone position, be in a horizontal position when taking blood, if there are signs of fainting (dizziness, nausea , increased sweating), you can use the following techniques: strongly clench your fingers into a fist, tighten the muscles of the hands, cross your legs, tighten the muscles of the thighs.