| ICD-10 | R55. |
|---|---|
| ICD-9 | 780.2 |
| eMedicine | med/3385 ped/2188 emerg/876 |
| MeSH | D013575 |
Fainting, frequently called syncope (pronounced /ˈsɪŋkəpi/), is a sudden, and generally momentary, loss of consciousness, or blacking out caused by the Central Ischaemic Response, because of a lack of sufficient blood and oxygen in the brain. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings R00-R69 - Symptoms and Signs (R00-R09 Circulatory and Respiratory systems ( Abnormalities of Heart beat The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Consciousness has been defined loosely as a constellation of attributes of Mind such as Subjectivity, Self-awareness, Sentience, and the The first symptoms a person feels before fainting are dizziness; a dimming of vision, or brownout; tinnitus; and feeling hot. Many different terms are often used to describe what is collectively known as dizziness. A brownout, or grey-out, is a transient loss of vision characterised by a perceived dimming of light accompanied by a brown hue and a loss of peripheral vision Tinnitus (tɪˈnaɪtəs or /ˈtɪnɪtəs/ from the Latin word for " Ringing " is the perception of sound within the human ear in the absence of corresponding Moments later, the person's vision turns black, and he or she drops to the floor (or slumps if seated in a chair). If the person is unable to slump from the position to a near horizontal position, he or she risks dying of the Suspension trauma effect. Suspension trauma, also known as harness hang syndrome (HHS, is an effect which occurs when the human body is held upright without any movement for a period of time
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Causes
Factors that influence fainting are taking in too little food and fluids, low blood pressure, hypoglycemia, growth spurts, physical exercise in excess of the energy reserve of the body, emotional distress, and lack of sleep. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Orthostatic hypotension caused by standing up too quickly or being in a very hot room can also cause fainting. Orthostatic hypotension (also known as postural hypotension, and colloquially as head rush or a dizzy spell) is a form of Hypotension in which
More serious causes of fainting include cardiac (heart-related) causes such as an abnormal heart rhythm (an arrhythmia), where the heart beats too slowly, too rapidly or too irregularly to pump enough blood to the brain. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Dysrhythmia redirects here For the American band see Dysrhythmia (band. Some arrhythmias can be life-threatening. Other important cardio-vascular conditions that can be manifested by syncope include subclavian steal syndrome and aortic stenosis. In medicine subclavian steal syndrome (SSS also subclavian steal phenomenon and subclavian steal steno-occlusive disease, is a constellation of signs
Fainting can also occur due to submersion in both shallow and deep water. A shallow water blackout is a loss of consciousness caused by Cerebral hypoxia towards the end of a breath-hold dive in water typically shallower than five A deep water blackout is a loss of consciousness caused by Cerebral hypoxia on ascending from a deep Freedive or breath-hold dive typically of ten metres or more
Treatment
Recommended treatment involves returning blood to the brain by laying the person on the ground with legs slightly elevated or they should lean forwards with their head between their knees. As the dizziness and the momentary blindness passes, the person may experience a brief period of visual disturbances in the form of phosphenes, sudden sore throat, nausea and general shakiness. This is a medical definition of entoptic phenomena For an alternative use within archaeology please see Entoptic phenomena (archaeology Entoptic phenomena are visual "Phosphene" is also a common alternative spelling of Phosphine, PH3 a toxic and explosive gas After the symptoms have passed, sleep is recommended. Sleep is a Natural state of bodily rest observed throughout the animal kingdom
Types
Vasovagal (situational) syncope, one of the most common types, may occur in scary, embarrassing, or uneasy situations or during blood drawing, coughing, or urinating. Other types include postural syncope (caused by a changing in body posture), cardiac syncope (due to heart-related conditions), and neurological syncope (due to neurological conditions). There are many other causes of syncope including low blood sugar levels and lung disease such as emphysema and a pulmonary embolus. The cause of the fainting can be determined by a doctor using a complete history, physical, and various diagnostic tests.
Vasovagal syncope
The vasovagal type can be considered in two forms:
- Isolated episodes of loss of consciousness, unheralded by any warning symptoms for more than a few moments. These tend to occur in the adolescent age group, and may be associated with fasting, exercise, abdominal straining or circumstances promoting vaso-dilatation (eg heat, alcohol). The subject is invariably upright. The tilt-table test, if performed, is generally negative. A tilt table test is a Medical procedure often used to diagnose Dysautonomia or syncope.
- Recurrent syncope with complex associated symptoms. This is so-called Neurally Mediated Syncope (NMS). It is associated with any of the following: preceding or succeeding sleepiness, preceding visual disturbance ("spots before the eyes"), sweating, light-headedness. The subject is usually but not always upright. The tilt-table test, if performed, is generally positive.
A pattern of background factors contributes to the attacks. There is typically an unsuspected relatively low blood volume, for instance, from taking a low salt diet in the absence of any salt-retaining tendency. Heat causes vaso-dilatation and worsens the effect of the relatively insufficient blood volume. That sets the scene, but the next stage is the adrenergic response. If there is underlying fear or anxiety (e. g. social circumstances), or acute fear (e. g. acute threat, needle phobia), the vaso-motor centre demands an increased pumping action by the heart (flight or fight response). This is set in motion via the adrenergic (sympathetic) outflow from the brain but the heart is unable to meet requirement because of the low blood volume, or decreased return. The high (ineffective) sympathetic activity is always modulated by vagal outflow, in these cases leading to excessive slowing of heart rate. The abnormality lies in this excessive vagal response. The tilt-table test typically evokes the attack.
Much of this pathway was discovered in animal experiments by Bezold (Vienna) in the 1860s. In animals, it may represent a defence mechanism when confronted by danger ("playing possum"). This reflex occurs in only some people and may be similar to that described in animals.
The mechanism described here suggests that a practical way to prevent attacks would be, counter-intuitively, to block the adrenergic signal with a beta-blocker. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias A simpler plan might be to explain the mechanism, discuss causes of fear, and optimise salt as well as water intake.
Pure cardiac syncope
Fainting can also occur if pressure on the carotid artery in the neck triggers a vagal signal to the Vaso-Motor Centre, reflexly causing a vagal response to slow the heart.
A pure cardiac arrhythmia is a serious matter that can appear as syncope but this is unusual. Severe narrowing of the Aortic Valve leading to syncope is included for completeness.
Syncope from vertebro-basilar arterial disease
Arterial disease in the upper spinal cord, or lower brain, causes syncope if there is a reduction in blood supply, which may occur with extending the neck or after drugs to lower blood pressure.
Clinical symptoms
A pre- or near-syncope is diagnosed if the individual can remember events during the loss of consciousness (i. e. reports remembering dizziness, blurred vision and muscle weakness and the fall previous to hitting their head and losing consciousness). Blurred vision is an Ocular Symptom. Causes There are many causes of blurred vision including use of Atropine. Muscle weakness (or "lack of strength" is a direct term for the inability to exert force with one's Muscles to the degree that would be expected given the individual's If the individual remembers feeling dizzy and loss of vision, but not the fall, then it is considered a syncoptic episode.
As loss of consciousness is a symptom for a variety of conditions and syncope is difficult to rule out outside of a hospital, a thorough examination is required to determine the cause, including interviews with witnesses as well as evaluation with an electrocardiogram. A hospital is an institution for Health care providing treatment by specialised staff and equipment and often but not always providing for
Clinical Tests
If one is suffering from syncope, there are many underlying causes that may be contributing to the episodes. It is important to understand that there is no master list of tests that are currently being used to diagnose the underlying cause(s). That being said, there are some common diagnostic tests for fainting.
- Blood Tests
- A hemoglobin count may indicate anemia or blood loss. However, this has been shown to be useful in only about 5% of patients being evaluated for fainting [1]
- Electrocardiograms
- An electrocardiogram (ECG) records the electrical activity of your heart. It is estimated that from 20%-50% of patients will have an abnormal ECG. However, while an ECG may identify conditions such as atrial fibrillation, heart block, or a new or old heart attack, it typically does not provide a definite diagnosis fo the underlying cause for fainting. [2]
- Holter monitor testing
- Sometimes, one may be asked to wear a holter monitor. In Medicine, a Holter monitor (also called an ambulatory electrocardiography device) named after its inventor Dr This is a portable ECG devise that can record your heart rhythms during daily activities over an extended period of time. Since fainting usually does not occur upon command, a holter monitor can provide a better understanding of your heart's activity during fainting episodes.
- Tilt table test
- This is perhaps the most common test performed for syncope, and though it can be helpful, the purpose is to induce a fainting episode . A tilt table test is a Medical procedure often used to diagnose Dysautonomia or syncope. . . which you already know happens. It is not necessarily conclusive in why this occurs.
Cultural
Fainting in women was a commonplace trope or stereotype in Victorian England and in contemporary and modern depictions of the period. Culture The Victorian fascination with novelty resulted in a deep interest in the relationship between modernity and cultural continuities Partly this may have been due to genuine ill-health (the respiratory effects of corsets are frequently cited), but it was encouraged by the myth of female invalidity, in which it was fashionable for women to affect an aristocratic frailty and create a scene by fainting at a dramatic moment. A corset is a Garment worn to mold and shape the Torso into a desired shape for Aesthetic or medical purposes (either for the duration of wearing it or
Children sometimes will play the 'fainting game', deliberately restricting blood flow to the brain in order to induce syncope. The fainting game, also commonly known as the choking or the pass out game, is a loose term that covers dangerous activities designed to induce a partial or complete [3]
Notes
- ^ Grubb (2001) p. 83
- ^ Grubb (2001) pp. 83-84
- ^ "'Choking Game' Becoming Deadly Fad For Adolescents", WJZTV Baltimore, 2005-11-04. Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. Events 1333 - Flood of the Arno River, causing massive damage in Florence as recorded by the Florentine chronicler Giovanni Villani Retrieved on 2008-02-13. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1258 - Baghdad falls to the Mongols, and the Abbasid Caliphate is destroyed
References
- Grubb, Blair P. The Fainting Phenomenon; Understanding Why People Faint and What to Do About It. 2001. 2nd ed. New York: Blackwell Publishing, 2007
See also
External links
- 2004 European Society of Cardiology Guidelines on Management (Diagnosis and Treatment) of Syncope.
- Dysautonomia Information Network
- Tilt table test
- Archive of Fainting Experiences
- WebMD Fainting First Aid
Dictionary
fainting
-noun
- An act of collapsing to a state to temporary unconsciousness.
-verb
- Present participle of faint.
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