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Cardiac Syncope- Causes, Clinical Manifestations, Management, and Immediate Action

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Cardiac Syncope- Causes, Clinical Manifestations, Management, and Immediate Action

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Cardiac syncope refers to loss of consciousness with impulsive recovery due to no passage of blood to the brain. This article discusses cardiac syncope in brief.

Medically reviewed by

Dr. Isaac Gana

Published At July 11, 2022
Reviewed AtFebruary 21, 2023

Introduction

Syncope, pronounced as sing-kuh-pee, is the medical terminology used for passing out. In simple terms, it means to faint. It is a common condition. Syncope occurs due to the short-term sinking of the blood that passes to the brain. This condition can also happen if there is a sudden drop in blood pressure. Recovery is voluntary, and confusion is a common trait experienced post syncope. Another reason for syncope may be an underlying dysfunction in the ANS. ANS or the autonomic nervous system is in control of multiple functions of the body that take place without our notice, such as breathing, heart rate, and urinary bladder control.

What Is Cardiac Syncope?

Syncope affects approximately 40 % of the population. It is a phenomenon that leads to the sudden and abrupt loss of consciousness along with an imbalance of postural tone. Syncope is of different types, and it can be categorized into cardiac syncope, orthostatic syncope, and neurally-mediated syncope. Cardiac syncope is when the sole reason for fainting is related to the cardiovascular system, for the most part, the heart and the heart’s vasculature. Cardiac syncope accounts for a small percentage of all syncope, approximately 10 %. Cardiac syncope is relatively life-threatening and demands deep investigation into its causes in addition to immediate treatment. They are potentially fatal, with a mortality rate of roughly 30 %.

What Causes Cardiac Syncope?

Syncope is caused by a temporary overall failure of cerebral microcirculation. The heart ceases to give rise to adequate cardiac output to give out fresh oxygenated blood to the brain, and this causes a cardiac syncope. Most often, cardiac syncope is due to arrhythmia. An arrhythmia occurs when the heart’s electrical system is malfunctioning and thus is producing an abnormally fast or an unusually slow heart rate. Another reason for a cardiac syncope can be an obstructive pathology within the heart or, in simple terms, an obstruction present in the heart’s structure. Some examples of these are tumors, aortic stenosis, myocardial infarction, or congenital hypertrophy. These obstructions lead to valve rupture and cardiac tissue damage. It should be noted that cardiovascular diseases are the second most common cause of syncope, with arrhythmias being far more common than obstruction diseases. Also, obstruction diseases are more generally found in patients with comorbidities like diabetes, hypertension, obesity, and in chain smokers.

What Are the Clinical Signs and Symptoms of Cardiac Syncope?

The cornerstones for evaluating cardiac syncope are the patient’s medical history and physical examination. History of syncopal episodes, underlying medical abnormalities, comorbidities, cardiovascular medications are all valuable assets. A keen eye for the patient’s hydration status, symptoms such as confusion and hyperventilation before syncope, and the status of the patient after regaining consciousness should be maintained. It is always helpful if the patient beforehand informs the healthcare provider regarding their history of syncope. A thorough physical examination that includes blood pressure checks on arms, as well as legs and heart rate, is vital in both supine and standing positions. The classical signs include sudden headache, feeling dizzy, confusion, blacking out, imbalance, having tunnel vision, palpitations, and feeling lightheaded. All the above are called premonitory symptoms. Syncope can be a warning sign for more severe conditions, so it is always wise to schedule an appointment with a doctor after an episode of syncope.

Mentioned below are a few of the signs and symptoms of cardiac syncope.

  • Restlessness.

  • Palpitations.

  • Sweating.

  • Nausea.

  • Vomiting.

  • Headache.

  • Dizziness.

  • Difficulty to comprehend.

  • Verbal incompetency.

  • Ringing of the ears.

  • Loss of balance.

  • Heavy breathing.

  • Confusion.

  • Altered state of mind.

  • Shortness of breath.

  • Tunnel vision.

  • Loss of consciousness.

  • Vertigo.

  • Hypotension.

How Can Syncope Be Managed?

The management of syncope starts with careful diagnosis and evaluation of the condition. Your doctor may ask you a series of related questions and may also make you go through specific necessary tests. These tests evaluate the state of the heart and its functioning. Particular blood work to rule out underlying conditions such as anemia may also be conducted. Other tests include an electrocardiogram (ECG), TMT- treadmill test, and tests to check the working of the autonomic nervous system, such as autonomic reflex tests. On the basis of the results of these tests and many more, changes in diet, medications, lifestyle are advised. The aim of syncope management is to reduce recurrence and mortality rate and is directed at correcting underlying causes, especially advanced cardiac illness.

Cardiovascular syncope or cardiac syncope requires immediate attention because it can be one of the signs of an underlying cardiovascular disease. Early prevention and diagnosis are key factors to prevent cardiac syncope. The patient must visit the healthcare provider at the first sign of any of the symptoms of cardiac syncope. Maintaining a healthy balance between diet and physical activity by consuming fruits and vegetables, doing regular exercise, and living a life full of activeness are a few of the preventive measures for cardiac syncope.

How Can I Help a Syncope Patient?

“The difference between a thought and a decision is the immediate action taken.”

Bearing this in mind, look out for the obvious signs, including blue lips, pale skin, difficulty breathing, confused behavior, and chest pain. Make sure you lay the patient flat and elevate their legs to restore blood flow into the brain. If the patient is wearing tight-fitting clothes, loosen them to reduce suffocation and make way for smooth blood circulation throughout. Try reviving the patient from unconsciousness by yelling their name or tapping them briskly. If the patient gains consciousness, give them sweet fluids like cold orange juice. In rare cases, if there is bleeding or vomiting, tilt the patient to one side and immediately call for an ambulance.

Conclusion

Syncope is a common condition that affects all age groups. Cardiac syncope is presented generally in older patients and is relatively rare amongst the younger population. Primary healthcare providers usually identify cardiac syncope. The diagnosis of cardiac syncope must be aligned with a medical history and appropriate diagnostic tools. Simple on-spot management includes raising the legs while in a prone position, sitting down while feeling dizzy, and keeping yourself hydrated throughout the day.

Frequently Asked Questions

1.

What Is the Differentiating Factor Between Cardiac Syncope and Non-Cardiac Syncope?

When there is a family history of any cardiovascular disease, the episodes of syncope are usually cardiac-based.

2.

What Are the Non-Evident Conditions That Lead to Cardiac Syncope?

- Emotional disturbance.
- Deep vein thrombosis.
- Abnormality in the oxygen saturation levels.

3.

Why Does Microvascular Disease Cause Syncope?

Microvascular diseases constrict the blood vessels and thus increase blood pressure. They may also act in the opposite manner leading to syncope.

4.

What Causes Shortness of Breath, Pallor, and Cyanosis During Syncope?

Vasovagal syncope leads to shortness of breath, pallor, and cyanosis.

5.

What Happens Just Before Fainting?

The patient blacks out, and the vision is blurred just before fainting. At times, a strong headache may also occur.

6.

What Cardiac Changes Can Lead To Syncope?

Electrical alterations in the impulses generated to the heart may lead to the insufficient blood supply to the brain and thus lead to syncope.

7.

How Does Syncope Affect the Quality of Life

Syncope can be easily managed by avoiding and checking the causes that develop it. By this, the quality of life is not hindered.

8.

How to Prevent Fainting?

- Being hydrated at all times.
- Avoiding overcrowded placed.
- Not sitting up suddenly after lying down.
- Being flat after a sudden headache or blurred vision.
- Eating or drinking glucose after vigorous activities.

9.

Can the Cause of Syncope Be Found Out?

Electrocardiography or ECG has been known to positively detect the cause of syncope.

10.

Is Fainting Different From Syncope?

Syncope, fainting, or passing out are three words that are synonymous with each other.

11.

Can Syncope Damage the Brain?

Since there have not been any radiological findings on the brain just after syncope, it is not sure if there is any brain damage as a result of syncope.

12.

Can Syncope Cause Seizures?

Studies have found that syncope may be an understated trigger factor of seizures in patients suffering from neurological diseases.

13.

Can Syncope Occur During Sleep?

Sleep syncope is also called sleep fainting and has been studied over several trials and cases.

14.

How to Differentiate Between an Episode of Syncope or Seizure?

Syncope is when the patient faints or loses consciousness, whereas seizures are when there are repeated jerking movements of the limbs.
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Dr. Isaac Gana
Dr. Isaac Gana

Cardiology

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