|
|
 |
 |
 |
| Thursday, 9 December 2004 |
 |
|
 |
Features | |
| News Business Features Editorial Security Politics World Letters Sports Obituaries
|
Syncope - causes and treatment options by Dr. D.P. Atukorale It may be that you woke up on the ground, embarrassed and scared. You may even have injured yourself. Why did you faint? Is this a sign of a serious health problem? Syncope (fainting) has many causes. In majority of cases it is not serious. In other cases, syncope is a sign of a heart problem. But treatment can bring you back to normal and active life. What is syncope? If your blood pressure (B.P.) drop too low, your brain may not get enough oxygen-rich blood, Your body responds by losing consciousness briefly. You may slump or fall down. This problem is called syncope, or a blackout or fainting. Syncope happens suddenly. But you may have warning signs first. These can include blurring of vision, light headedness or palpitations due to fast heart beat. Or you may have no warning signs at all. After syncope you recover quickly if you lie flat or somebody raises your legs. What the people who come to help should not do is to make the person stand up or make him sit up. You may feel tired for a few minutes or you many sometimes have nausea or vomiting. Syncope is a common problem with many possible causes. For instance syncope may be caused by standing for too long or sitting up too fast. In some cases you may never faint again. But if heart trouble causes syncope this can be serious. To provide the best treatment your family physician will want to learn why you fainted. If heart trouble is causing your syncope, treatment may even save your life. Treatment options Your treatment options depend on what is causing your syncope. a) You may be advised to adjust your life or lifestyle to help avoid fainting. b) Use or adjust medications. c) Have a procedure or surgery to control a heart problem. Your heart pumps oxygen-rich blood to the brain and the rest of the body. Your heart rate and blood pressure increase or decrease as needed. But sometimes the blood pressure decrease too much. Then the brain does not get enough oxygen - rich blood and you faint. Your brain and body need a steady supply of oxygen - rich blood. Your heart rate and blood pressure adjust to maintain this steady blood supply throughout all your activities. The heart creates electrical signals that travel through it on pathways. These signals set the heart rate and tell the heart when to pump blood. In response to your body's needs your brain may also trigger changes in your heart rate and blood pressure. This keeps your blood flow strong. When syncope is not serious Even healthy people get syncope. This is because your body may be sensitive to certain strains and stress. Your family physician may diagnose your problem as vasovagal syncope or orthostatic hypotension. These 2 types of syncope are not serious. They can be caused by - (a) strong feelings such as anxiety or fear. A nerve signal may briefly change your heart rate (and pulse rate) and lower B.P. too much. Thus some people especially females faint when they hear of a bad news such as death of a close relative. I have come across wives of heart attack patients who faint when they are told that the husbands have got a heart attack. There are instances when medicos faint in the operation theatre when they watch surgical operations for the first time. (b) Standing for too long may cause blood to pool in your legs. When this happens, your brain may not receive all the blood it needs. (c) Standing up too quickly can cause syncope. Your blood pressure may not adjust fast enough to changes in posture. As a result B.P. may drop too low. This is more common in elderly people and certain patients on certain medications such as prazocin prescribed for hypertension. When heart trouble causes syncope A heart problem can decrease the amount of oxygen - rich blood that reaches the brain. Your heart rate may be too slow as in case of heart block or many be too fast as in case of certain heart rhythm disturbances such as certain tachycardia. Or a damaged heart value (Such as aortic valve stenosis) may decrease blood flow. If the heart does not pump blood enough, your BP may drop too low and you may faint. Heart trouble can be serious and may even be fatal if left untreated. Slow heart rate Electrical impulses tell the chambers of the heart when to pump. But the signals may be slowed or blocked (heart block) as they travel on the hearts pathways. Heart block can be caused by aging, scarred heart tissue, or damage from heart disease. When the heart rate slows, not enough blood is pumped to the brain and rest of the body. Fast heart rate Certain problems can make the heart race. For instance after a heart attack, abnormal electrical impulses can make the heart suddenly beat very fast. The heart pumps before the chambers can fill with blood. So less blood reaches the brain. Illegal drugs, certain medications, heart disease or an inherited heart condition can also cause this. Heart valves open and close to help move blood in the right direction. If the valve is hardened or scarred, the valve may not open or close fully and less blood is pumped through the heart to the brain and body. Diagnosing syncope Your physician may after take a history about the syncopal attack and your past history and family history and after doing a good physical examination may order a few tests such as the ECG, Echo cardiogram, Holter monitoring, Tilt Table testing and electrophysiological studies (EPS). Small changes make a big difference Making a few small changes can often help to prevent a fainting attack. Your doctor may suggest the following. (a) Don't stand for long (b) Sit near the aisle in crowded places. Then you can leave if you feel faintish. (c) Wear specially prescribed stockings to keep blood from pooling in your legs. (d) Get up slowly after you have been lying down. Sit for a moment before standing. (e) Watch what you eat. if advised by your family physician, add salt to your diet to raise BP if your B.P. is low. Don't skip meals. (f) Drink water often, especially when exercising and during hot weather. (g) Limit your driving as directed. If You Feel Faint (a) Learn the warning signs of fainting such as weakness, nausea, dimmed vision, sweating, lightheadedness or a fast heart beat. (b) Don't ignore or fight any signs that you may faint. (c) Lie down until you feel better. Your symptoms should go away in about 20 minutes. (d) Sit down and put your head between your knees if you can't lie down. Role of medications Tell your physician all about the medications you are taking. Your medications may have to be changed or reduced. Your physician may prescribe certain medications. Pacemaker A pacemaker can be implanted in the chest to speed up slow heart beat (heart block). An ICD An implantable cardioverter defibrillator slows down a fast heart beat. An ICD often contains a pacemaker, and also sends one or more electric shocks to restore normal heartbeat. Catheter ablation is used in certain cases of fast heart beat and this procedure changes part of hearts electrical system by destroying abnormal pathways or cells. If you have heart valve problems surgery may be the best for you and the valve may be rebuilt or replaced |
|
News | Business | Features
| Editorial | Security
Produced by Lake House |
