“The eyes see the brain knows.” This ancient motto is famous in the medical echelon, emphasizing why fainting is important in clinical medicine because it is often missed when evaluating patients.
Syncose is caused by a temporary loss of consciousness caused by insufficient brain perfusion. In short, this is a brief cutoff of reality, accompanied by the loss of tone and posture, once the perfusion of the brain is restored, it is restored with consciousness.
The roads to the fainting hospital are as diverse as the reasons. This is the endpoint of multiple pathology – nerves, orthostatic hypotension, heart, all of which have special origins – evolutionary bane.
Humans adopt an upright posture, providing themselves with a larger range. However, this creates unique physiological stress in the human body – to maintain constant perfusion pressure on the brain gravity. Therefore, about 1 liter of blood merges in the vascular plexus of the lower limbs, which is absorbed from the central circulation. The solution is the brain to automatically adjust. Automatic brain regulation refers to the brain’s ability to maintain constant/stabilize blood despite changes in the volume of blood circulation in the central circulation.
When this brain autoregulation changes, it leads to the end result of fainting, a brief, self-limiting loss of consciousness, so brief that the patient or his caregiver may not even recognize it.
Some syncope case studies
The following case study is an interesting example.
A 27-year-old man introduced repeated cracks in his upper limbs to the orthopedic department over three months, all of which occurred in his bathroom. A doctor friend of the orthopedic doctor linked the waterfall in the bathroom to urinating fainting (drowsy when urinating), a rare type that occurs after urination, highlighting the importance of interdisciplinary coordination in health.
Vascular syncope occurs when the nervous system overreacts to stimulation – pain, emotions, cough, swallowing, anxiety, etc., also known as nerve-mediated syncope, which causes parasympathetic outflow and sympathetic inhibition, resulting in the final effect – final effect – syncope.
Intraocular pressure, intraocular examinations, fear and anxiety, recurrent cough, respiratory instruments, postur urination and bowel movements, total gastric neuralgia (severe attack of oral pain), and cervical sinus massage are more common causes of nerve-mediated fainting.
It is important to diagnose neuromediated syncope as it can save unnecessary research and patient time loss, as most cases improve with the reassurance and awareness of the event and avoid stimulation. First aid measures for isometric counter pressure manipulation, such as handle and limb tension, can aid miscarriage and fainting.
Dizziness, dizziness, dizziness and weakness with auditory and visual symptoms. This suggests that the brain is beginning to find it difficult to work with the blood supply and its supply pressure, which means reducing the onset of brain perfusion pressure.
In another case, a 78-year-old woman was referred to the third-level care setting that assesses knee flexion over the past three months. The anxiety of knee flexion won’t make her fall asleep because, if she does, it will cause her to fall out of bed after she wakes up. This is also a fainting situation. But how can a person stay awake for three months? The answer is her armchair, where she will sleep comfortably after three hours of lunch until her son comes back from get off work. It turns out that this is a simple case of fainting caused by orthostatic hypotension, which is treated by asking her to sit in her supine position and then stand up for a few minutes, then succumb to her knee flexion completely disappear!
Orthostatic hypotension is a diastolic pressure reduction of at least 20 mmHg and at least 10 mmHg after standing up from the supine position for three minutes. This is the result of blood concentration caused by sympathetic vasoconstrictive hypoefficiency, which is secondary to gravity. The most common cause is autonomic dysfunction in diabetes.
With the increase in the elderly population, female thyroxine disease, such as Parkinson’s disease and multisystem atrophy, witnessed orthostatic hypotension in the elderly.
Like all conditions in medicine, reversible causes are eliminated. Non-pharmacological interventions need to be explained to the patient, such as phased movement to upright posture, avoiding large meals and isometric counterpressure operations.
In the third case, we studied a 43-year-old woman whose case was multiple pre-months and multiple Presyncopal episodes occur every other month. Her nerve and cardiac assessment was normal without osteopathic hypotension. Multiple investigations were futile. A keen doctor glanced at his neck and found a goat. Her thyroid profile shows that she is hyperthyroidism, which causes her to suffer from paroxysmal atrial fibrillation, leading to presynchronization. Antithyroid medications ensure she never had a previous episode again.
Heart fainting is caused by arrhythmia or by structural heart disease. The idea is to look for arrhythmia in a comprehensive way, which, as mentioned above, may be paroxysmal. Cardiomyopathy may be susceptible to arrhythmia, which can lead to fainting.
So, why fainting remains a mystery?
This is mainly due to multiple differential diagnosis it throws to the doctor. Doctors must explain fainting from seizures, hypoglycemia, paralysis, and psychosis (such as anxiety and panic disorders and physical illnesses).
The thumb rule of loss of consciousness over 5 minutes of epilepsy seizures is a great guide. Another guide would be postal chaos, which is significant in the absence of fainting.
Cataplexy is known for its complete consciousness, loss of taste and posture. Hypoglycemia is usually identified by the presence of hunger, which does not exist in fainting. A history of oral hypoglycemia or insulin medications is essential to narrow down investigations. Low CBG is highly diagnostic.
Patients need to be evaluated on an OPD-based basis with a detailed but sharp medical history with special attention to the history of psychiatric illness, as well as blood pressure targeted at orthostatic hypotension, and the cardiac causes of ECG rule out syncope. Targeted studies on anemia, thyroid profile, uremia, and liver function are better than conventional baseline blood tests. Here, it is usually not usually necessary to evaluate the autonomic nervous system to be tested on a routine basis.
Detailed cardiovascular assessment, Holter monitor equipped with 24-hour ECG, and outpatient BP monitoring with 2D echocardiography ensures comprehensive baseline work. Rare causes can be discovered through treadmill testing, covering exercise-induced arrhythmias.
Syncose is a common problem, causing approximately 3% of all hospitals to be admitted. Knowledge of fainting can be diagnosed early, greatly reducing Daley (year of life after disability adjustment). Although most of the investigations were conducted on an OP basis, certain diseases (such as coronary ischemia, atrial fibrillation, tortuous blocks, and ECG) have long QT, as well as a family history of sudden heart death.
Syncose is one of the rare demonstrations that require a wide range of methods that include all systems in the body.
(Dr. Arvind Radhakrishnan is a final year general medicine graduate student who can simplify the health of everyone through medical communication. Arvindradhakrishnan97@gmail.com)
publishing – April 20, 2025 02:03 pm ist
