syncope
Introduction
Fainting introduction Fainting is a sudden, transient, transient loss of consciousness and faints, caused by temporary cerebral ischemia, hypoxia, and natural recovery in a short period of time. The production of fainting can be due to a significant reduction in cardiac output, or a transient cardiac arrest. Peripheral vascular resistance in the large circulation decreases, or due to insufficient blood supply to the local brain. When the human body is standing, the cardiac output stops for 1 to 2 seconds, and there is a feeling of dizziness and weakness. In 3 to 4 seconds, loss of consciousness can occur. basic knowledge Sickness ratio: 60% Susceptible people: no specific population Mode of infection: non-infectious Complications: disturbance of consciousness
Cause
Fainting cause
Heart disease (30%):
Due to arrhythmia, myocardial infarction and other causes of sudden decrease in cardiac output, especially in atrioventricular block, ventricular paroxysmal tachycardia.
Transient cerebral insufficiency (15%):
This is a common fainting, (1) due to increased vagal tone, (2) orthostatic syncope, more often occurs when the supine position is turned upright, (3) carotid sinus allergic fainting.
Urinary stimulation (20%):
Suddenly occurs during urination or after urination, more common in men, especially when getting up at night to urinate or when the urine is too long.
Cerebrovascular disease (18%):
Fainting due to damage to the intracranial or extracranial cerebral vascular disease or the vasomotor center itself.
Other factors (25%):
Common in patients with chronic obstructive pulmonary disease or emphysema, blood loss and fainting, acute massive blood loss and water loss caused by various reasons, effective circulation reduction caused by sudden reduction, alpine adaptation wave and hypoglycemia Fainting is caused by insufficient oxygen content and blood sugar levels in the inhaled air.
Prevention
Fainting prevention
1. When the patient falls into a fainting episode, he should be supine, quickly untie the collar, pay attention to keep the airway open, and when you are too many, you should suck, so as not to block the sputum, the airway is unfavorable. When the patient starts to wake up, don't rush to sit. Start, don't stand up, you should lie flat for a few minutes, then sit up slowly, so as not to faint again.
2. Because there are often auras before the onset of this card, when there are dizziness, cold sweat, palpitation, pale complexion and other prodromal symptoms, you should immediately lie on your face to avoid falls, for the weakness of the body, after illness or senile qi Those who are deficient should pay attention to avoid excessive fatigue, do not stand too long, the action should be slow when changing position, not too urgent, so as not to induce fainting.
3. Should pay attention to anger, anger, and avoid emotional, and cause illness.
4. People who are rich in body fat and wet, should eat light, quit smoking and alcohol.
5. Occasional cases, after waking up, pay attention to conditioning, avoid recurrence; often repeatedly author, to find out the cause, to be actively treated.
Complication
Fainting complications Complications
It can be recovered naturally in a short time without special complications.
Symptom
Fainting symptoms common symptoms pale conscious loss of consciousness disorder fatigue hypotension trauma anxiety tongue bite convulsion water loss
Lost consciousness for a short time.
Twitching: Twitching is a manifestation of involuntary movement and a pathological phenomenon of neuro-muscular disease, manifested as an involuntary contraction of the striated muscle.
Hypotension: refers to a state in which the systemic arterial pressure is lower than normal.
The pale face is pale: the face is caused by insufficient filling of the capillaries on the face.
Other symptoms include fatigue, tongue bites, water loss, trauma, anxiety, severe pain, and fear.
Examine
Fainting check
First, the test:
1. Carotid sinus stimulation and carotid compression test.
2, two-eye compression method: the examiner presses the patient's double eyeball with the thumb and forefinger. The positive person may have fainting in 10 to 15 seconds, and the body is weak, and the high myopia and severe heart disease are disabled.
3, blowing method: the patient lying or sitting, after the conventional electrocardiogram and / or EEG examination, the patient with deep inhalation, close the nose and mouth, immediately breathe, can also exhaust, 15 seconds after the ECG And / or EEG review, a variety of heart rhythm disorders or brain waves are positive, some patients may have fainting or convulsions, the above positive test can help diagnose, but the negative can not be excluded from fainting.
Second, ECG, cardiac B-ultrasound and other tests are generally applicable to all types of cardiogenic fainting, reflex fainting; EEG examination for brain-derived fainting, cardiogenic and reflex fainting; carotid and vertebral artery Doppler ultrasonography Cerebral angiography, cranial CT and cerebrospinal fluid examination are suitable for brain-derived fainting, as well as cervical vertebrae and chest radiographs, blood sugar, blood lipids, etc. can also be examined as appropriate.
Diagnosis
Fainting diagnosis
diagnosis
First, the characteristics of medical history
1. In addition to directly understanding the patient's medical history, the witnesses are also required to provide the current situation, including the situation before the fainting, whether there is a warning, etc.; the degree and duration of the disturbance of consciousness during the fainting, and the complexion, pulse, Whether there is urinary incontinence and limb twitching; and subjective discomfort after recovery of consciousness.
2, pay attention to the cause of fainting episodes, such as simple fainting often have sorrow, fear, anxiety, fainting, see blood, trauma, severe pain, sultry, fatigue and other stimulating factors; cardiogenic fainting is more common in excessive exercise or improper medication; Also pay attention to whether there are urinary, stool, cough, blood loss and other incentives.
3, pay attention to the position and head position at the time of onset, erect hypotension fainting occurs mostly from the supine position to the standing position, carotid sinus allergic fainting occurs mostly in the head position suddenly.
4, pay attention to the speed and time of fainting, such as reflex fainting, the general onset is slightly slow, time is short; cardiogenic fainting is generally sudden onset, the length of time is different; brain-derived fainting generally slow onset, length of time Not one.
5, pay attention to the clinical manifestations of fainting, generally sudden loss of consciousness, fall, pale, cold limbs, no convulsions, no trauma and tongue bite and urinary incontinence.
Second, check the body
Special attention should be paid to the examination of the cardiovascular system, with or without valvular heart disease, heart rhythm disorders, blood pressure in different postures, abnormal pulse, neck pulsation and abnormal murmur.
Differential diagnosis
1. Absence of seizures (small seizures), mainly manifested as paroxysmal short-term disturbances, sudden loss of consciousness, holding objects, no obvious incentives and auras, generally no downfall and no feeling of fatigue after seizures, EEG examination helps Differential diagnosis.
2. cataplexy, mainly manifested as - sudden onset - excessive systemic muscle tension, soft sputum fell to the ground, without eye black, disturbance of consciousness and cold sweat, etc., often in the case of laughter, after the onset of illness No discomfort.
3. Dizziness, mainly manifested as the rotation of oneself or foreign objects, because the standing is not lying on the ground, accompanied by nausea, vomiting and nystagmus, generally unconscious disorder, lasting for tens of minutes, gradually improving after hours or days. .
4. Shock, mainly manifested as pale, weak pulse, cold sweat, blood pressure drop or not detected, early consciousness is clear.
