Syncope

Clinic

• Syncope is an entity which belongs to Autonomic Dysregulation series of entities
• It refers to Reflex syncope/ Vasovagal Syncope / Orthostatic hypotension
• It is a brief loss of consciousness due to a neurologically induced drop in blood pressure and/or a decrease in heart rate.
• Before an affected person passes out, there may be sweating, a decreased ability to see, or ringing in the ears.
• Occasionally, the person may twitch while unconscious
• It is located in opposite side of Sympathetic hyperactivity

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

Causes

1. Vasovagal: Typically triggered by seeing blood, pain, emotional stress, or prolonged standing.
2. Situational: Triggered by urination, swallowing, or coughing
3. Carotid sinus: Due to pressure on the carotid sinus in the neck

Mechanism

There are two mechanisms that often act together

• Reflex syncope / Cardiogenic
• Neurogenic: Brain-stem is activation causes
  • Enhancement of parasympathetic / Vagal tone
  • Withdrawal of sympathetic nervous system tone

This results in a spectrum of hemodynamic responses

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 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 and coma as fixed SSPs and Bradycardia as changeable SSP.

Entity / Miasm

	RBS	SAHF	LSSV	YF	CXA-B	HSV-1	TBE
G/ Hypotention/ Orthostatic	+++	+++	+++	+++	+++	+++	+
Mind / Coma	+++	+++	+++	+++	+++	+++	+++
Heart/Bradycardia	+++	+++	+++	+++
G/ Nervous system	+++	+++		+++	+++

• SAHF is the best for both Cardiogenic and Neurogenic Syncope. Intrestingly SAHF has Vasoconstriction which is very Consonant to circulatory origin.
• YF, CXA-B, ECHO and RBS are good candidates of Neurogenic Syncope

Related diseases

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

• Autoimmune autonomic ganglionopathy
• Multiple system atrophy
• Other forms of dysautonomia
• Ehlers–Danlos syndrome
• Anorexia nervosa
• Parkinson's disease
• Lewy body dementias : Resulting from sympathetic denervation of the heart or as a side effect of dopaminomimetic therapy. This rarely leads to fainting unless the person has developed true autonomic failure or has an unrelated heart problem. Chronic orthostatic hypotension is associated with cerebral hypoperfusion that may accelerate the pathophysiology of dementia.

Another disease, dopamine beta hydroxylase deficiency, also thought to be underdiagnosed, causes loss of sympathetic noradrenergic function and is characterized by low or extremely low levels of norepinephrine, but an excess of dopamine.

Quadriplegics and paraplegics also might experience these symptoms due to multiple systems' inability to maintain normal blood pressure and blood flow to the upper part of the body.

• Patients prone to orthostatic hypotension are the elderly, post partum mothers, and those having been on bed rest. People with anorexia nervosa and bulimia nervosa often develop orthostatic hypotension as a common side effect. Consuming alcohol may also lead to orthostatic hypotension due to its dehydrating effects

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.