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Syncope
Syncope (fainting spells) has a variety of causes, most of
which are not life threatening. Occasionally, syncope is
caused by a neurologic problem such as a seizure or unusual
migraine headache; however, you may be referred to a
Cardiologist to determine if there is a cardiac (heart)
cause of the syncope.
How is it recognized?
The diagnosis may be made at any age, depending on the
severity of the narrowing. Poor or absent pulses in the legs
or high blood pressure in the arm with lower leg blood
pressure with a heart murmur may indicate that a
coarctation may be
present.
Cardiac Causes
- Rhythm abnormality: The heart beats too fast, too
slow, or irregularly. (Least common in children)
- Irregularities in the involuntary (autonomic)
nervous system: Causes low blood pressure and low blood
flow to the brain leading to syncope. The body’s
response of falling to the ground (fainting) will
increase blood flow to the brain and the return of
consciousness. The lying position is actually one of the
forms of therapy. This common form of syncope has the
medical name of neurally mediated syncope, however, it
may also be called neurocardiogenic, vasovagal,
vasodepressor, simple faint, church syncope, or
breath-holding spell. (Most common in children)
Mechanism
The typical mechanism of neurally mediated syncope is an
inappropriate relaxation of the blood vessels and lowering
of the heart rate, leading to low blood pressure at a time
when the body actually needs constriction of the blood
vessels and a slightly higher heart rate. It is unclear why
this occurs. Diagnostic Tests (One or more may be done)
- EKG (electrocardiogram): to check heart rate and rhythm.
- Holter Monitor: a 24-hour EKG to monitor any irregularities
in a 24-hour period.
- Loop Recorder: continuous recording of the heartbeat.
- Tilt Table Test: a test where you are tilted to a near
standing position with your legs held still in an effort to
cause syncope while the heartbeat and blood pressure are
being monitored.
Treatment for the Common Type of Syncope
- Hydration: Increase fluid intake to at least 8-10
glasses per day, especially decaffeinated beverages such
as Gatorade, ginger-ale, Sprite, fruit juices, or sports
drinks. Water can be included, but it should not be the
only fluid. It is a good idea to drink 12-16 ounces of
one of the above named beverages just before a period of
vigorous exercise. Salt should also be included in the
diet, either in cooking or at the table.
- Recognition: Learn to be aware of symptoms that can
occur before syncope such as dizziness,
light-headedness, sweating, nausea, buzzing in the ears,
spinning, or looking pale to others. If you or your
child experience any of these symptoms, you can follow
antigravity maneuvers described in the following section
to avoid fainting.
- Antigravity Maneuvers: Actions that can be taken to
avoid fainting reduce the effects of gravity on the
blood in your body. These include:
- Lie down on your back with your knees bent or bend
to a low squat.
- Cross your legs and tense your abdominal muscles
while standing.
- Place one foot on a chair or stool with the other
foot on the ground.
Other Treatments
If these methods fail to work, there are medicines that
may be used to control neurally mediated syncope.
The most common medicine prescribed in children and
adolescence is Florinef. Its primary effect is to make
the kidneys retain sodium and water. The side effects
that can be of concern are high blood pressure, which
can occur 2-4 weeks after starting this medicine, or leg
cramps from a slightly low potassium level. If Florinef
is prescribed, you should increase your/your child’s
dietary potassium by eating bananas and drinking fruit
juices.
Another class of medicines that can be used include
beta-blockers, such as Atenolol, Propanolol, Nadolol,
and Metoprolol. These medicines block the effects of
adrenaline on the heart and help prevent the abnormal
reflex, which leads to syncope. These medicines seem to
be most useful for patients who have symptoms during or
after exercise. Side effects may include fatigue and
diminished exercise performance. Most patients tolerate
both types of medicines without problems.
If the therapies prescribed for you or your child are
not working, or you have questions, please call your
doctor.
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