4

the cause of orthostatic hypotensive faints is structural damage to the autonomic nervous system due to systemic diseases (e.g., amyloidosis or diabetes) or in neurological diseases (e.g., Parkinson’s disease).

5 SOCIETY AND CULTURE

stored and retrieved by their physician and some devices can be monitored remotely.

2.5Other causes

Factors that influence fainting are fasting long hours, taking in too little food and fluids, low blood pressure, hypoglycemia, high g-force, emotional distress, and lack of sleep.

Fainting can occur in “cough syncope”.[10] following severe fits of coughing, such as that associated with pertussis or “whooping cough.”

3.1 San Francisco syncope rule

The San Francisco syncope rule was developed to isolate people who have higher risk for a serious cause of syncope. High risk is anyone who has: congestive heart failure, hematocrit <30%, electrocardiograph abnormality, shortness of breath, or systolic blood pressure <90 mm Hg.[15] The San Francisco syncope rule however was not validated by subsequent studies.[16]

3Diagnostic approach

For people with uncomplicated syncope (without seizures and a normal neurological exam) computed tomography or MRI is not indicated.[11] Likewise, using carotid ultrasonography on the premise of identifying carotid artery disease as a cause of syncope also is not indicated.[12] Although sometimes investigated as a cause of syncope, carotid artery problems are unlikely to cause that condition.[12]

A hemoglobin count may indicate anemia or blood loss. However, this has been useful in only about 5% of patients evaluated for fainting.[13]

An electrocardiogram (ECG) records the electrical activity of the heart. It is estimated that from 20% 50% of patients 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 for the underlying cause for fainting.[14]

Sometimes, a Holter monitor may be used. This is a portable ECG device that can record the wearer’s 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 the heart’s activity during fainting episodes.

The Tilt table test is performed to elicit orthostatic syncope secondary to autonomic dysfunction (neurogenic).

For patients with more than two episodes of syncope and no diagnosis on “routine testing”, an insertable cardiac monitor might be used. It lasts 28–36 months. Smaller than a pack of gum, it is inserted just beneath the skin in the upper chest area. The procedure typically takes 15 to 20 minutes. Once inserted, the device continuously monitors the rate and rhythm of the heart. Upon waking from a “fainting” spell, the patient places a hand held pager size device called an Activator over the implanted device and simply presses a button. This information is

4 Management

Recommended acute treatment of vasovagal and orthostatic (hypotension) syncope involves returning blood to the brain by positioning the person on the ground, with legs slightly elevated or leaning forward and the head between the knees for at least 10–15 minutes, preferably in a cool and quiet place. For individuals who have problems with chronic fainting spells, therapy should focus on recognizing the triggers and learning techniques to keep from fainting. At the appearance of warning signs such as lightheadedness, nausea, or cold and clammy skin, counterpressure maneuvers that involve gripping fingers into a fist, tensing the arms, and crossing the legs or squeezing the thighs together can be used to ward o a fainting spell. After the symptoms have passed, sleep is recommended. If fainting spells occur often without a triggering event, syncope may be a sign of an underlying heart disease. In case syncope is caused by cardiac disease, the treatment is much more sophisticated than that of vasovagal syncope and may involve pacemakers and implantable cardioverter-defibrillators depending on the precise cardiac cause.

5 Society and culture

Fainting in women was a commonplace trope or stereotype in Victorian England and in contemporary and modern depictions of the period. This may have been partly due to genuine ill health (the respiratory e ects of corsets are frequently cited), but it was fashionable for women to a ect an aristocratic frailty and create a scene by fainting at a dramatic moment.

Some individuals occasionally or frequently play the "fainting game" (also referred to in the US as the “choking game”), which involves the deliberate induction of syncope via voluntary restriction of blood flow to the brain, an action that can result in acute or cumulative brain damage and even death.[17]

6See also

Voodoo death

7References

[1]Peeters, SY; Hoek, AE; Mollink, SM; Hu , JS (April 2014). “Syncope: risk stratification and clinical decision making.”. Emergency medicine practice 16 (4): 1–22; quiz 22–3. PMID 25105200.

younger and older Western patient populations.”.

Progress in cardiovascular diseases 55 (4): 357–63. doi:10.1016/j.pcad.2012.11.006. PMID 23472771.

[3]Ruwald, MH (August 2013). “Epidemiological studies on syncope--a register based approach.”. Danish medical journal 60 (8): B4702. PMID 24063058.

[4]Gaynor D, Egan J (2011). “Vasovagal syncope (the common faint): what clinicians need to know”. The Irish Psychologist 37 (7): 176–9. hdl:10147/135366.

[5]Bracha HS (July 2006). “Human brain evolution and the 'Neuroevolutionary Time-depth Principle:' Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzonerelated posttraumatic stress disorder”. Prog. Neuropsychopharmacol. Biol. Psychiatry 30 (5): 827–53. doi:10.1016/j.pnpbp.2006.01.008. PMID 16563589.

[6]Manisty C, Hughes-Roberts Y, Kaddoura S (July 2009). “Cardiac manifestations and sequelae of gastrointestinal disorders”. Br J Cardiol 16 (4): 175–80. Retrieved 11 May 2013.

[7]Freeman, Roy (2011). “Chapter 20: Syncope”. In Longo, Dan L.; Kasper, Dennis L.; Jameson, J. Larry; Fauci, Anthony S.; Hauser, Stephen L.; Loscalzo, Joseph. Harrison’s Principles of Internal Medicine (Textbook) (18th ed.). New York, NY: The McGraw-Hill Companies. pp. 171–177. ISBN 978-0-07-174889-6.

[8]Nallamothu BK, Mehta RH, Saint S et al. (October 2002). “Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications”. Am. J. Med. 113 (6): 468–71. doi:10.1016/S0002-9343(02)01254-8. PMID 12427495.

[9]Jamjoom AA, Nikkar-Esfahani A, Fitzgerald JE (2009). “Operating theatre related syncope in medical students: a cross sectional study”. BMC Med Educ 9: 14. doi:10.1186/1472-6920-9-14. PMC 2657145. PMID 19284564.

[10]Dicpinigaitis PV, Lim L, Farmakidis C (February 2014). “Cough syncope.”. Respiratory Medicine 108 (2): 244– 51. doi:10.1016/j.rmed.2013.10.020. PMID 24238768.

[11]Moya A, Sutton R, Ammirati F et al. (November 2009). “Guidelines for the diagnosis and management of syncope (version 2009)". Eur. Heart J. 30 (21): 2631–71.

5

doi:10.1093/eurheartj/ehp298. PMC 3295536. PMID 19713422.

[12]American Academy of Neurology (February 2013), “Five Things Physicians and Patients Should Question”,

Choosing Wisely: an initiative of the ABIM Foundation

(American Academy of Neurology), retrieved August 1, 2013, which cites:

(a)Strickberger, S. A.; Benson, D. W.; Biaggioni, I.; Callans, D. J.; Cohen, M. I.; Ellenbogen, K. A.; Epstein, A. E.; Friedman, P.; Goldberger, J.; Heidenreich, P. A.; Klein, G. J.; Knight, B. P.; Morillo, C. A.; Myerburg, R. J.; Sila, C. A.; American Heart Association Councils On Clinical Cardiology (2006). “AHA/ACCF Scientific Statement on the Evaluation of Syncope: From the American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, and the Quality of Care and Outcomes Research Interdisciplinary Working Group; and the American College of Cardiology Foundation: In Collaboration with the Heart Rhythm Society: Endorsed by the American Autonomic Society”. Circulation 113 (2): 316–327. doi:10.1161/CIRCULATIONAHA.105.170274. PMID 16418451.

Moya, A.; European Society of Cardiology (ESC); Sutton, R.; European Heart Rhythm Association (EHRA); Ammirati, F.; and Heart Rhythm Society (HRS); Blanc, J.-J.; Endorsed by the following societies; Brignole, M.; European Society of Emergency Medicine (EuSEM); Moya, J. B.; European Federation of Internal Medicine (EFIM); Sutton, J.-C.; European Union Geriatric Medicine Society (EUGMS); Ammirati, J.; Blanc, K.; European Neurological Society (ENS); Brignole, A.; European Federation of Autonomic Societies (EFAS); Dahm, M.; Deharo, M.; Gajek, T.; Gjesdal, R. R.; Krahn, F.; Massin, A.; Pepi, J. G.; Pezawas, E. P.; Ruiz Granell, W.; Sarasin, H.; Ungar, D. G. et al. (2009). “Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)".

European Heart Journal 30 (21): 2631– 2671. doi:10.1093/eurheartj/ehp298. PMC 3295536. PMID 19713422.

NICE (August 2010), Transient loss of consciousness in adults and young people (CG109), NICE, retrieved 24 October 2013

[13]Grubb (2001) p.83

[14]Grubb (2001) pp.83-84

6

Francisco Syncope Rule to predict patients with serious outcomes”. Ann Emerg Med 47 (5): 448–

54.doi:10.1016/j.annemergmed.2005.11.019. PMID 16631985. Lay summary – Journal Watch (July 21, 2006).

[16]Birnbaum A, Esses D, Bijur P, Wollowitz A, Gallagher EJ (August 2008). “Failure to validate the San Francisco Syncope Rule in an independent emergency department population”. Ann Emerg Med 52 (2): 151–

9.doi:10.1016/j.annemergmed.2007.12.007. PMID 18282636.

[17]"'Choking Game' Becoming Deadly Fad For Adolescents”. WJZ-TV Baltimore. 2005-11-04. Archived from the original on 2007-12-19. Retrieved 2008-02-13.

8External links

Syncope (medicine) at DMOZ

2004 European Society of Cardiology Guidelines on Management (Diagnosis and Treatment) of Syncope.

Tilt table test

The San Francisco syncope rule

8 EXTERNAL LINKS