Syncope

Clinic

• Syncope, commonly known as fainting, or passing out
• Due to its etiology, syncope has three forms
  1. Orthostatic syncope
  2. Reflex syncope (Vasovagal Syncope)

Orthostatic syncope

• It refers to syncope resulting from a postural decrease in blood pressure.
• It occurs when there is a persistent reduction in blood pressure of at least 20mmHg systolic or 10mmHg diastolic within 3 minutes of standing or being upright to 60 degrees on the head-up tilt table.
• In people with initial orthostatic hypotension, the decrease in blood pressure occurs within 15 seconds, while in those with delayed orthostatic hypotension it occurs after over 3 minutes of assuming an upright position.

Reflex syncope

• Reflex syncope is a brief loss of consciousness due to a neurologically induced drop in blood pressure and/or a decrease in heart rate.
• It is divided into three types:
  1. Vasovagal which is typically triggered by seeing blood, pain, emotional stress, or prolonged standing.
  2. Situational which is often triggered by urination, swallowing, or coughing.
  3. Carotid sinus which is due to pressure on the carotid sinus in the neck.

Sign / Symptom

• Loss of consciousness

• Light-headedness, Nausea
• Feeling of hot / cold + sweating
• Ringing in the ears
• Uncomfortable feeling in heart
• Confusion: Slight inability to speak or form words
• Visual disturbances such as lights seeming too bright, fuzzy or tunnel vision, black cloud-like spots in vision
• Nervousness

Mechanism

Orthostatic syncope

Reflex syncope

In upright position, there is an immediate gravitational pooling blood to the lower extremities, splanchnic and pulmonary circulations. The decrease in venous return to the heart reduces cardiac output and eventually causes a drop in blood pressure. Carotid and aortic Baroreceptors sense this decrease in blood pressure and activate the sympathetic nervous system which leads to increased heart rate, systemic vasoconstriction, and increased cardiac muscle contractility all of which eventually increase blood pressure. In Autonomic dysfunction, there is an inadequate engagement of the autonomic nervous system in response to a decrease in blood pressure leading to persistent hypotension.

Enhancement in parasympathetic tone which lends in Negative chronotropic effect: Bradycardia Negative inotropic effect leading to a decrease in cardiac output and loss of consciousness withdrawal of sympathetic nervous system tone, which leads in vasodepressor response and a drop in blood pressure without much change in heart rate. But vasovagal syncope often have a mixed response.

Dynamic vs Static SSPs

• Syncope has a lot of Symptoms, but most of them are post-nodes.
• It means that Confusion, Dizziness, Blurred vision, Fatigue, Coma and Ext coldness are all caused by Hypotention.
• In another word they are not caused by the miasm dependently, but they are the direct effect of hypotention.
• So I delete all of them. I suggest only Orthostatic Hypotention as fixed SSP and Bradycardia as changeable SSP.
• Also I suggest the rubric

Entity / Miasm

• I can only suggest one rubric, which is G/ Hypotention/ Orthostatic and have 7 miasms: SAHF, HSV-1, CMV, HIV, HTLV-1, LBB, TBE

Related diseases

• Addison's disease
• Atherosclerosis
• Diabetes
• Pheochromocytoma
• Porphyria

• Autoimmune autonomic ganglionopathy
• Multiple system atrophy
• Ehlers–Danlos syndrome
• Anorexia nervosa, Bulimia nervosa
• Parkinson's disease
• Lewy body dementias

Note

Cardiogenic Neurological and syncopes usually come together but there is some guides to be differentiated from each other

• Hypotention of Cardiogenic origin occurred in 2-3 min, but in Neurologic one, Hypotention occurred immediately.
• Cardiogenic syncope is accompanied by valvular heart diseases, myocardial diseases, and cardiac arrhythmia, while neurologic syncope has neurologic causes.
• Neurologic Syncope is more often in elderly people.