Easy to faint

Introduction Syncope refers to a sudden loss of transient consciousness caused by a sudden, widespread, insufficient blood supply to the brain. It is caused by physical factors and can also be secondary to blood circulation disorders in the brain. Old people, intense exercise after sedentary, etc. are easy to faint.

Cause

The cause of fainting:

First, vasomotor dysfunction

1. Vasopressive syncope: induces syncope due to pain, tension, fear, fear, and various traumas.

2. Orthostatic hypotension, also known as orthostatic hypotension, is common in long-term illness after standing in bed suddenly; pregnant women or standing too long; elderly and infirm, squatting for too long, suddenly stand up and other reasons to induce syncope.

3. Carotid sinus syndrome, usually caused by sudden rotation of the neck or collar tightness, is related to carotid atherosclerosis or stenosis.

4. Urinary syncope, common in male adults, induces syncope when urinating in the morning or midnight or at the end of urination.

5. Cough and syncope.

Second, cardiogenic syncope: such as a variety of arrhythmia, sinus syndrome, Aspen syndrome and cardiomyopathy, myocardial infarction.

Third, brain-derived syncope: common in cerebral arteriosclerosis, transient cerebral ischemia, vertebral artery disease, aortic arch syndrome and epileptic seizures.

Fourth, other: such as hypoglycemia, severe anemia, acute blood loss, asphyxia, gas poisoning and hyperventilation syndrome.

an examination

Related inspection

Electrocardiogram, general film examination, full meal test

Easy faint examination 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 and pulse at that time. , with or without urinary incontinence and limb twitching; and subjective discomfort after recovery of consciousness.

(B) pay attention to the cause of fainting episodes, such as simple fainting often have sorrow, fear, anxiety, fainting, seeing 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 incentives such as urination, stool, cough, blood loss and water loss.

(3) Pay attention to the position and head position at the time of onset. The upright hypotension fainting occurs mostly when changing from the lying position to the standing position. The carotid sinus allergic fainting occurs mostly in the head position and suddenly rotates.

(D) pay attention to the speed and time of fainting episodes, 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 is generally slower onset, time Different lengths.

(5) Pay attention to the clinical manifestations of fainting, generally sudden loss of consciousness, falling, pale, cold limbs, no convulsions, no trauma and tongue bite and urinary incontinence.

Second, physical examination: should pay special attention to check the cardiovascular system, if there is no heart valve disease, heart rhythm disorder, blood pressure, pulse abnormalities in different positions, neck artery pulsation weakened and abnormal noise.

Third, the relevant laboratory inspection:

(1) Incentive test:

1. Carotid sinus stimulation and carotid compression test. The examiner first massages the patient's unilateral carotid sinus with the thumb, alternating between left and right. When needed, the bilateral carotid sinus can be massaged at the same time. The massage time is 30 seconds. If there is a positive reaction, stop the massage immediately. If it is a negative reaction, The thumb is used to force the carotid artery of the patient, alternating left and right, and the general compression duration is 30 seconds. If there is a positive reaction, the abnormality usually occurs in 10-30 seconds. At the same time as the above tests, the patient's clinical manifestations should be closely observed, blood pressure, electrocardiogram and electroencephalogram should be monitored. Once abnormalities are found, carotid massage or compression should be terminated. This inspection is carried out under conditions of rescue equipment and drugs to prevent accidents.

2. Both eyes still need compression method: the examiner presses the patient's double eyeball with the thumb and forefinger, and the positive person may have fainting in 10-15 seconds. Infirm, high myopia and severe heart disease are banned.

3. Blowing method: the patient is lying or sitting, after the routine electrocardiogram and / or EEG examination, the patient closes the nose and mouth after deep inhalation, immediately breathes, can also exhaust, and then make an electrocardiogram after 15 seconds And / or EEG review, a variety of heart rhythm disorders or brain waves are positive. Some patients may have fainting or convulsions. Those who are positive in the above tests are helpful in diagnosis, but those who are negative cannot be excluded from fainting.

(2) Auxiliary inspection:

Electrocardiogram, cardiac B-ultrasound and other examinations are generally applicable to all types of cardiogenic fainting, reflex fainting; EEG examination for brain-borne fainting, cardiogenic and reflex fainting; carotid and vertebral artery Doppler ultrasonography, brain Angiography, cranial CT and cerebrospinal fluid examination are suitable for brain-derived fainting. There are also cervical spine and chest radiographs, blood sugar, blood lipids, etc. can also be checked as appropriate.

Differential diagnosis

Symptoms that are confusing and confusing:

Transient fainting, also called simple, vascular fainting, is a sudden and short-lived loss of consciousness, which can be accompanied by systemic precursor symptoms such as dizziness, dizziness, tinnitus, pale and cold sweat, etc. There are upright hypotension; urinary fainting and a long-term hot bath.

Syncope refers to a sudden loss of transient consciousness caused by a sudden, widespread, insufficient blood supply to the brain. It is caused by physical factors and can also be secondary to blood circulation disorders in the brain. Its clinical features are acute onset and loss of transient consciousness. Patients often have prodromal symptoms about one minute before the onset of syncope, manifested as general discomfort, blurred vision, tinnitus, nausea, pale, cold sweat, limb weakness, and soon syncope. At the onset of syncope, casual exercise and loss of sensation, sometimes apnea, slow heart rate, and even cardiac arrest, it is difficult to touch the radial artery and the carotid artery. Neurological examination can reveal dilated pupils, loss of light reflection and corneal reflexes, reduction or disappearance of sputum reflexes, pathological reflexes, often accompanied by salivation and urinary incontinence. It usually lasts for 2-3 minutes, and all functions are gradually restored. After the patient wakes up, there may be a short period of conscious turbidity, abdominal discomfort, nausea, vomiting, constipation, even incontinence, extreme fatigue, lethargy, duration of a few minutes to half an hour, after the onset of examination can be no positive signs.

Repeated episodes of syncope: It is often fainting, with certain repeatability. May have acute pulmonary infarction or paroxysmal supraventricular tachycardia, cardiogenic syncope. Clinical manifestations such as decreased blood pressure, slow heart rate and weak, pale, should pay attention to the presence or absence of urinary incontinence, limb convulsions, biting the tongue and the duration of the attack.

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