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Syncope disease


Syncope is a temporary loss of consciousness, pridruzhena loss of postural tone, followed by spontaneous recovery. Although in most cases, syncope is a benign reason, the incidence of cardiac arrhythmias as a cause of syncope in the elderly is high. Patients with partial recovery after a syncopal episode not true syncope. In these cases, it is a disease in which syncope is part of the clinical picture.

In about half of patients the cause of syncope can not be established. Despite the many reasons leading to syncope, the overall mechanism for the temporary loss of consciousness is the lowered oxygen supply to the brain by disorders of cerebral blood flow. The most common cause of syncope is reflex-mediated disruption of the sympathetic response to stress, leading to relatively increased vagal tone with hypotension and / or bradycardia (autonomic dysfunction).

Vasovagal syncope occurs due to emotional stress or injury in combination with long standing. Precursor presented by dizziness, impaired vision ( “black spots”), paleness, sweating and nausea. Postural syncope occurs in healthy subjects after long standing. Pathological postural syncope was observed in patients in the elderly with chronic diseases leading to the development of the central and peripheral neuropathies. This type of syncopal episode occurs usually after getting up from a lying or sitting position.

In examining these patients syncopal attack could occur again in a repeat of the movement that led to syncope. It almost all cases can be found orthostatic hypotension. More serious causes of syncope are orthostatic conditions occurring with liquid deficit – vomiting, diarrhea, bleeding, polyuria and sepsis. Carotid hypersensitivity can lead to syncope in patients bearing a narrow collar shirt, shaving or suddenly turning the head sideways before syncopal attack.

Pain – induced syncope is associated with severe visceral pain in conditions such as aneurysms of the abdominal aorta or ruptured ectopic pregnancy. Multiple vasoactive drugs can also lead to syncope. Cardiac syncope may be due to arrhythmia or structural cardiopulmonary lesion. Almost all irregular heart rhythm and conduction may lead to syncope. Sankopat due to dysrhythmias usually occurs suddenly and is very short prodromal period.

Structural abnormalities of the heart are manifested in the form of syncope in carrying out physical exertion or when taking vasoactive drugs. In patients in the elderly the most common cause is aortic stenosis, whereas in young patients, it is hypertrophic cardiomyopathy. Other causes of cardiac syncope can be myxoma, pulmonary embolism and dysfunction of an artificial heart valve.

Situational syncope is caused by difficulty in venous return to the heart, leading to a sharp decrease in cardiac output and cerebral hypoperfusion. He was seen in the unintended execution of Valsalva maneuver with enhanced vagal reflex kardiodepresoren in cases of paroxysmal cough (tusiven syncope), difficulty in micturition and defecation. Cerebrovascular pathology is a rare cause of syncope. If the reason is ischemia of the brain stem and reticular formation, patients report accompanying symptoms resulting deficit in the rear brain circulation – diplopia, dizziness and nausea.

Steal syndrome Subclavian artery caused by squeezing her during exercise and movement of the upper limbs. Typically, when physical examination was no difference in blood pressure measured between both hands> 20 mm Hg.

Hypoventilation syncope was observed in the states of emotional stress, which are prodromal twitch and spasm of the lips, limbs and facial muscles.

Topliniiyat syncope due to liquid deficiency and peripheral (skin) vasodilation. Transient loss of consciousness occurs due to cerebral hypoperfusion and is common in the elderly and poor acclimatized individuals. In these patients are possible injuries vsledstie of syncope.

Subarachnoid hemorrhage may lead to syncope through autonomous mechanisms or cerebral vasospasm. Cerebral apoplexy usually cause more coma than syncope. The presence of headache, photophobia, vomiting, neck pain or signs of meningeal irritation confirm the diagnosis.

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