What is syncope in children and adults - causes, diagnosis and treatment methods. Fainting. Causes, diagnosis and treatment Classification subtypes of syndromes

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Arrhythmia

An arrhythmia leading to syncope should be corrected accordingly. Cardiac pacing, ICD placement, and catheter ablation are common treatments, the choice of which depends on the mechanism of arrhythmogenic syncope.

Pacemaker insertion has proven to be highly effective in patients with sinus node dysfunction leading to bradyarrhythmia accompanied by syncope or increased sinus node recovery time. Although no randomized controlled trials have been conducted on this issue, it is clear from several observational studies that pacemaker insertion improves survival and prevents recurrence of syncope in patients with heart block. It has been suggested, but not proven, that a pacemaker may also be effective for BBB and syncope, both of which are thought to be caused by transient AV block.

Due to its curative effects, catheter ablation is considered the treatment of choice for the most common forms of atrial arrhythmias that cause syncope. The effectiveness of conventional antiarrhythmic therapy in the case when the arrhythmia manifests itself as syncope is insufficient.

Iatrogenic atrial and ventricular arrhythmias are treated by eliminating the underlying cause of the disorder.

Insertion of an ICD is the method of choice in patients with organic heart disease, in which VT and VF cause syncope and are recorded by ECG, or occurred during ventricular pacing. A number of non-randomized trials have evaluated the efficacy of ICDs in patients with severe ischemia and non-ischemic cardiomyopathy accompanied by undocumented syncope, possibly related to ventricular tachyarrhythmia. They had a high frequency of defibrillations, which indicated the potential benefit of performing this manipulation. In table. Table 1 presents the generally accepted indications for the installation of an ICD for the prevention of sudden death in patients with syncope. Carrying out catheter ablation is justified in patients without organic heart disease. On the contrary, the effectiveness of traditional antiarrhythmic treatment is considered insufficient.

Table 1

Situations in which implantation of a cardioverter-defibrillator is most justified

Organic heart and lung diseases

Treatment is aimed at eliminating specific structural lesions or their consequences.

Michele Brignole, Jean-Jacques Blanc, Richard Sutton and Angel Moya

Fainting, also known as syncope or syncope in the language of official medicine, is a short-term disturbance of consciousness, usually leading to a fall.

The word "syncope" is of Greek origin ( syn- with, together; koptein- cut off, cut off), later this word migrated to the Latin language - syncopa from which it came into musical terminology (syncope). However, in clinical medicine, it is customary to use terms that are etymologically related to the Greek language to denote pathological conditions, so the word “syncope” is still more correct.

In some cases, the development of fainting is preceded by a variety of symptoms, which is called lipothymia (weakness, sweating, headache, dizziness, visual disturbances, tinnitus, a premonition of an imminent fall), but more often syncope develops suddenly, sometimes against the background of "complete well-being".

At the same time, the presence of precursors of fainting is not similar to the aura that accompanies epileptic seizures. The harbingers of fainting are more "earthly" in nature and are never expressed in the form of bizarre sensations: the smell of roses, auditory hallucinations, etc.

Sometimes patients with habitual fainting, when lipothymia appears, may have time to sit or lie down, inflict painful irritations on themselves (pinch themselves or bite their lip), trying to avoid loss of consciousness. Often this succeeds.

The duration of loss of consciousness during fainting, as a rule, is 15-30 seconds, less often it drags on for up to several minutes. Protracted syncope can cause significant difficulties when trying to distinguish them from other diseases that may be accompanied by disorders of consciousness.

Not every time it is possible to distinguish an epileptic seizure from a faint. With prolonged fainting, as with a seizure, twitching of the muscles of the trunk and face may be noted. The only thing is that patients with fainting never arch into an arc - they do not have what is called generalized convulsions (simultaneous convulsive contraction of many muscles).

Causes of syncope

The cause of fainting is a sudden decrease in blood flow to the brain. With a sharp decrease in cerebral blood flow, six seconds may already be enough for the consciousness to turn off.

There may be several reasons behind this incident:

• reflex decrease in arterial tone or disruption of the heart, accompanied by a decrease in the amount of blood expelled from it;
• heart rhythm disturbances (sharp bradycardia or tachycardia, short-term episodes of cardiac arrest);
• changes in the heart, as a result of which there are disorders of blood flow inside the heart chambers (malformations).

The probable causes of fainting are different depending on age, in older people, first of all, disorders in the vessels that feed the brain (narrowing of these vessels caused by atherosclerosis) or various heart diseases should be suspected.

For young patients, fainting is more typical, developing as if in the absence of changes in the heart and blood vessels - most often these are fainting, which are based on impaired functioning of the nervous system or mental disorders.

In about one-third of all cases, the cause of fainting is never found, despite the ongoing examination.

One of the mechanisms for the development of fainting is the so-called orthostatic mechanism, a kind of human retribution for walking upright. The principle of orthostatic disorders is the insufficient supply of blood to the brain due to the victory of gravity and the accumulation of blood in the lower parts of the body. This occurs either due to insufficient vascular tone, or with a decrease in the volume of blood in the bloodstream.

Repeated fainting in a standing position can occur in people who have been suffering from diabetes mellitus for a long time, since this disrupts the innervation of blood vessels (autonomous diabetic neuropathy), with Parkinson's disease, with adrenal insufficiency (the amount of hormones responsible for maintaining blood pressure decreases).

A decrease in circulating blood volume can be caused by both bleeding and a decrease in the volume of the liquid part of the blood (for example, severe sweating in the heat, recurrent diarrhea, profuse vomiting).

In pregnant women, due to the inconsistency of the amount of blood with the needs of the "doubled" body, a tendency to fainting is also manifested.

Orthostatic reactions can provoke alcohol consumed in excessive doses, and some drugs. About drugs that can cause a short-term loss of consciousness, it should be said separately.

First of all, these are drugs that reduce blood pressure: drugs taken to dilate blood vessels and diuretics. When prescribing them, the doctor warns that the pressure may decrease excessively, so you should not walk for a long time after taking the medicine for the first time in your life or simply stand for a long time.

The most common are reactions to drugs based on nitroglycerin, so they should always be taken with great care.

Separately, I would like to warn: nitroglycerin is a drug intended for the treatment of angina pectoris. It is by no means a universal remedy for the treatment of all cases; in patients, at the time of fainting, sometimes there is a feeling of pressure in the region of the heart, stabbing pain and other discomfort in the chest.

Nitroglycerin, hastily thrust under the tongue, will only aggravate an already unpleasant situation. Therefore, in most cases of syncope, it should not be given, and if the need for this medicine is not in doubt, then at least an approximate estimate of the level of blood pressure is required. At low pressure, the presence of which can be suspected by such signs as a pulse of weak filling, cold and moist skin, nitroglycerin is contraindicated.

Drugs used to treat erectile dysfunction in men (sildenafil, vardenafil and tadalafil) can also contribute to the development of orthostatic reactions. The danger of their simultaneous administration with nitroglycerin is especially pointed out - the combined use of these drugs can very sharply reduce the level of blood pressure in the vessels due to a sharp expansion of the latter.

Another mechanism is involved in the basis neuroreflex syncope, the appearance of which is associated with irritation of certain reflexogenic zones. The triggered reflex causes a decrease in heart rate and vasodilation, which ultimately leads to a decrease in blood flow in the brain.

Receptors of the nervous system, the irritation of which can lead to fainting, are scattered throughout the body. Irritation of the ear with a funnel at an ENT doctor's appointment is one of the typical causes of fainting in medical institutions.

On the neck, not far from the angle of the lower jaw, in the place where the common carotid artery bifurcates, there are carotid sinus glomeruli, irritation of which can cause loss of consciousness. This trouble primarily concerns men with a short neck, to whom the conservative dress code prescribes a tight buttoning of collars, accompanied by a tightening of the tie.

Men can also suffer from irritation of this area with a razor. At one time, even the "barber's symptom" stood out. Oddly enough, but heavy jewelry (massive earrings or chains) can also provoke fainting, pressing or sometimes simply touching an overly active reflexogenic zone.

An increase in chest pressure that occurs when coughing, sneezing, or straining causes fainting in people with overly sensitive receptors in the lungs. Associated with this is the dizziness that sometimes occurs when breaststroke swimming.

Reflex impulses from the intestines, arising as a result of banal flatulence, causing even a short-term disorder of consciousness, makes one think of a serious catastrophe in the abdominal cavity. The same can be said about the reflexes from the bladder when it is overdistended due to urinary retention (associated with illness or even arbitrary).

The bladder is also associated with such an unpleasant faint as a faint that occurs in men at the time of urination. Anatomically, the urethra in a man is several times longer than in a woman, the resistance to urine flow is again higher, and the reasons for increasing this resistance are more often (prostate adenoma, for example). And then, having experienced several losses of consciousness, a man has to adapt to the situation that has arisen (for example, to urinate while sitting).

Syncopal states that develop against the background of erotic stimulation or against the background of orgasm look quite “romantic”. Alas, they are not associated with an emotional outburst, but with the activation of the reflexogenic areas of the genital organs.

In addition to vasodilation and a decrease in cardiac output, the cause of loss of consciousness can also be cardiac arrhythmias. Of all situations, these are the most dangerous for the patient, as they represent the greatest risk to life.

The fact is that some rhythm disorders that do not initially lead to cardiac arrest can, after a few seconds or minutes, cause a potentially fatal disorder when the fibers of the heart “twitch” in different directions without carrying out any coordinated activity and without “chasing away” blood through the vessels. This disorder is called "fibrillation".

It follows that any cardiac arrhythmias that cause impaired consciousness should be considered very seriously and be the reason for hospitalization in a hospital for the purpose of both in-depth examination and the choice of treatment or even surgery.

Diseases of the heart and lungs that cause transient disorders of consciousness are a rather heterogeneous group of diseases. These can be heart valve lesions, in which there is a violation of intracardiac blood flow, and pulmonary disorders, when an obstruction to normal blood flow occurs already in the pulmonary circulation.

Finally, damage to the blood vessels that directly feed the brain can also lead to fainting. The cause of fainting is both internal barriers to blood flow (large atherosclerotic plaques, for example), and compression of a large vessel by something from the outside.

According to current ideas, not all short-term disorders of consciousness are usually classified as syncope. Non-syncopal is the nature of loss of consciousness during an epileptic seizure, heat or sunstroke, hyperventilation disorder (acute panic attack, accompanied by deep and frequent breathing).

Separately, such a disease as syncope migraine stands out. Being similar to migraine in its main manifestation - headache, it has one fundamental difference. If a classic migraine attack is also resolved classically - with severe nausea and vomiting, which brings immediate relief, then with syncope migraine, the apotheosis of the attack is not vomiting, but fainting. Waking up, the patient realizes that the headache has disappeared somewhere or almost disappeared.

Such, for example, a rare diagnosis as myxoma (a tumor growing into the lumen of the heart on a thin stalk), may be suspected if syncope develops when turning from side to side. This happens because a tumor “dangling” freely enough in the lumen of the chambers of the heart, under certain positions, can block the blood flow through the heart valve.

When syncope occurs stereotypically during defecation, urination, coughing, or swallowing, one speaks of situational syncope.

The situation when syncope is associated with tilting the head back (as if the patient wanted to look at the ceiling or at the stars) has a beautiful name "Sistine Chapel Syndrome" and can be associated with both vascular pathology and hyperstimulation of the carotid sinus zones.

Syncopal conditions that occur during physical exertion suggest the presence of stenosis of the outflow tract of the left ventricle.

Establishing the cause of syncope can be greatly helped by the correct collection of complaints and medical history. The key points to be assessed are:

• establishing the posture in which syncope developed (standing, lying, sitting).

• clarification of the nature of the actions that led to syncope (standing, walking, turning the neck, physical exertion, defecation, urination, coughing, sneezing, swallowing).

• previous events (overeating, emotional reactions, etc.)

• detection of precursors of syncope (headache, dizziness, "aura", weakness, visual disturbances, etc.). Separately, you should find out the presence of symptoms such as nausea or vomiting before losing consciousness. Their absence makes one think about the possibility of developing cardiac arrhythmias.

• clarification of the circumstances of the syncopal episode itself - the duration, the nature of the fall (backwards, "sliding" or slow kneeling), the color of the skin, the presence or absence of convulsions and biting the tongue, the presence of respiratory disorders.

• characteristics of resolution of syncope - the presence of lethargy or confusion, involuntary urination or defecation, discoloration of the skin, nausea and vomiting, palpitations.

• anamnestic factors - a family history of sudden death, heart disease, syncope; a history of heart disease, lung disease, metabolic disorders (primarily diabetes and adrenal pathology); taking medications; data on previous syncope and examination results (if any).

In all cases of fainting, it may be necessary to make an electrocardiogram (if not immediately, then later). The fact is that a number of diseases that can cause heart rhythm disturbance, leading to loss of consciousness, are detected precisely with an ECG. In the worst case, loss of consciousness may be the debut of myocardial infarction, the diagnosis of which is also made on the basis of a cardiogram.

To confirm the orthostatic origin of syncope, an elementary test can be performed when measuring blood pressure. The first measurement is taken after a five-minute stay of the patient in the supine position. The patient then stands up and measurements are taken at one and three minutes.

In cases where the decrease in systolic pressure is more than 20 mm Hg. Art. (or below 90 mm Hg. Art.) is fixed in the first or third minutes, the sample should be considered positive. If the pressure reduction indicators do not reach the indicated values, but by the third minute the pressure continues to decrease, measurements should be continued every two minutes, either until the indicators stabilize or until critical numbers are reached. Naturally, this test should be carried out by a doctor.

Even if the usual test with the measurement of pressure did not give a result, suspicions of the orthostatic origin of syncope may still remain. For the final decision of a dubious issue, a “tilt test” is performed (from English, to tilt- tilt).

The patient is placed on the table and attached to this table so that when the table is tilted, it remains in a kind of "crucified" position. The table tilts, as if the patient is "put" on his feet, while determining changes in blood pressure during the transfer to a vertical position. A rapid decrease in blood pressure (and in rare cases, the development of pre-syncope) confirms the diagnosis of orthostatic syncope.

Blood pressure measurement should be taken on both arms. If the difference exceeds 10 mm Hg. Art., you can suspect the presence of aortoarteritis, subclavian artery syndrome or dissection of the aneurysm in the aortic arch, i.e. diseases, each of which can lead to uneven blood flow in the brain system, and each of which requires medical intervention.

Normally, in any person, the difference in pressure can reach 5-10% on two hands, but if these differences have become larger, increased or appeared for the first time in life, it makes sense to consult a doctor.

Treatment

Vasovagal syncope and other manifestations of the neuroreflex syndrome require only general measures - the patient should be placed in a place as cool as possible, with open access to fresh air, unfasten tight clothing or squeezing accessories (belt, collar, corset, bra, tie), give the legs an elevated position .

Turning the head to one side to prevent retraction of the tongue is allowed only if there is no damage to the subclavian, carotid and vertebral arteries.

The application of painful stimuli (slaps, for example), as a rule, is not required - the patient soon regains consciousness on his own. In protracted cases, a cotton wool with ammonia brought to the nose, or simply tickling the mucous membrane of the nasal passages, can accelerate the return of consciousness. The last two effects lead to the activation of the vasomotor and respiratory centers.

In a situation where previous profuse sweating led to the development of fainting, you should simply replenish the volume of fluid - give plenty of fluids. A universal remedy for post-fainting weakness is tea - a liquid plus caffeine, which maintains vascular tone and cardiac output, plus sugar, which is necessary taking into account possible hypoglycemia (low blood glucose).

Most syncope does not require specific drug therapy. Young patients prone to orthostatic reactions may be recommended to increase the amount of salty foods, and drugs that support vascular tone are occasionally prescribed.

Hospitalization

It is not required to place in a hospital patients with "habitual" or "situational" syncope, previously examined, not causing concern for further prognosis.

Patients are subject to hospitalization in order to clarify the diagnosis:

• with suspected heart disease, including with changes in the ECG;
• the development of syncope during exercise;
• family history of sudden death;
• sensations of arrhythmia or interruptions in the work of the heart immediately before syncope;
• recurrent syncope;
• development of syncope in the supine position.

Patients are subject to hospitalization for the purpose of treatment:

• with rhythm and conduction disturbances that led to the development of syncope;
• syncope, probably due to myocardial ischemia;
• secondary syncopal conditions in diseases of the heart and lungs;
• the presence of acute neurological symptoms;
• violations in the work of a permanent pacemaker;
• injuries resulting from a fall during syncope.

Despite the variety of phenomenological manifestations of paroxysms characterized by impaired consciousness, two main groups of paroxysmal disorders of consciousness are currently distinguished - epileptic And non-epileptic. In the structure of the last syncope(fainting) states occupy a leading place.

In some patients, convulsive syncope masquerades as epileptic seizures.. After an initial neurological examination, such patients are often prescribed treatment with antiepileptic drugs. Despite ongoing therapy, 25% of patients with epilepsy have syncope.

Recommendations of the American College of Cardiology/American Heart Association (ACC/AHA), European Heart Society (ESC) and others indicate that patients with syncope, presyncope, dizziness, or recurrent unexplained palpitations should be subject to mandatory electrocardiogram (ECG) monitoring. With the diagnostic capabilities of ECG monitors, it is possible to carry out long-term monitoring and diagnosis of transient or rare symptoms.

Classification of syncope

Considering the fact that syncope occurs in the clinical practice of internists of any profile, a unified approach to their classification is needed.

The following states are currently distinguished:
1. neurogenic syncope: psychogenic, irritative, maladaptive, dyscirculatory.
2. Somatogenic syncope: cardiogenic, vasodepressor, anemic, hypoglycemic, respiratory.
3. Syncopal conditions during extreme exposure: hypoxic, hypovolemic, intoxication, drug, hyperbaric.
4. Rare and multifactorial syncope: nocturic, cough.

In addition, considering fainting as a process unfolded in time, the severity of syncopal conditions is distinguished.
1. Presyncope:
I degree - weakness, nausea, flies before the eyes;
II degree - more pronounced symptoms described above with elements of impaired postural tone.
2. Syncope:
I degree - short-term shutdown of consciousness for a few seconds without a pronounced post-seizure syndrome;
II degree - a longer loss of consciousness and pronounced post-seizure manifestations.
The above classification emphasizes that syncopal paroxysm is a phased process in which transitional states can be distinguished.
fainting clinic

Fainting is characterized by:
generalized muscle weakness
decreased postural tone, inability to stand upright
loss of consciousness

The term "weakness" means a lack of strength with a feeling of impending loss of consciousness. At the beginning of fainting (!!!) the patient is always in an upright position, except for the Adams-Stokes attack. Usually the patient has a presentiment of impending fainting. At first, he becomes ill, then there is a feeling of movement or swaying of the floor and surrounding objects, the patient yawns, flies appear before his eyes, tinnitus, nausea, sometimes vomiting, vision is weakened. With a slow onset of syncope, the patient can prevent falls and injury by quickly assuming a horizontal position. In this case, there may not be a complete loss of consciousness.

The depth and duration of the unconscious state are different
sometimes the patient is not completely disconnected from the outside world
a deep coma may develop with complete loss of consciousness and lack of response to external stimuli.

A person can be in this state for several seconds or minutes, sometimes even about half an hour. As a rule, the patient lies motionless, skeletal muscles are relaxed, however, immediately after loss of consciousness, clonic twitches of the muscles of the face and trunk occur. The functions of the pelvic organs are usually controlled, the pulse is weak, sometimes not palpable, blood pressure (BP) is lowered, breathing is almost imperceptible. As soon as the patient assumes a horizontal position, blood flows to the brain, the pulse becomes stronger, breathing becomes more frequent and deep, the complexion normalizes, consciousness is restored. From this moment on, a person begins to adequately perceive the environment, but feels a sharp physical weakness, too hasty an attempt to get up can lead to repeated fainting.
Headache, drowsiness, and confusion usually do not occur after fainting.

Fainting of vascular origin

Vascular syncope includes conditions resulting from a drop in blood pressure or a decrease in venous return of blood to the heart:
vasovagal
sinocarotid
orthostatic
situational syncope.
psychogenic syncope is also distinguished as a result of the influence of psycho-emotional factors

Patients describe fainting as the appearance of a feeling of lightheadedness, dizziness. They turn pale, perspiration appears, then the patients lose consciousness. It is believed that the pathogenetic basis of vasovagal syncope is excessive deposition of blood in the veins of the lower extremities and a violation of reflex effects on the heart. Other variants of vasovagal syncope have also been described. With intense pain syndrome of visceral origin, irritation of the vagus nerve can contribute to a slowdown in cardiac activity and even cardiac arrest, for example, with an attack of hepatic colic, damage to the esophagus, mediastinum, bronchoscopy, pleural puncture and laparocentesis, severe systemic dizziness with labyrinthine and vestibular disorders, puncture of body cavities. Sometimes fainting develops with a severe migraine attack.

Sinocarotid syncope

They are characteristic of middle-aged people, are associated with irritation of the carotid sinus node and the development of reflex bradycardia, which lead to fainting. It occurs when the head is thrown back sharply or the neck is squeezed by a tightly tied tie or shirt collar. The specificity of the situation is the key to the diagnosis, for confirmation of which a careful unilateral massage of the carotid sinus in the horizontal position of the patient should be performed, preferably under ECG control to register bradycardia. Such a massage is informative from a diagnostic point of view in elderly patients, (!!!) but it should not be performed during an outpatient appointment if noises are heard over the carotid artery, indicating the presence of an atherosclerotic plaque, or if there is a history of ventricular tachycardia, a recent transient ischemic circulatory disorder, stroke or MI.

Orthostatic syncope

The main difference between orthostatic syncope- their appearance only when moving from a horizontal to a vertical position.
Orthostatic arterial hypotension is the cause of syncope in an average of 4-12% of patients.

This type of syncope occurs in individuals with chronic insufficiency or periodic instability of vasomotor reactions. A decrease in blood pressure after taking a vertical position occurs due to a violation of the vasoconstrictor reactivity of the vessels of the lower extremities, which are responsible for the resistance and capacity of the vessels.

Postural syncope develops in apparently healthy people who, for unknown reasons, have inadequate postural responses (which may be familial). In such people, a feeling of weakness occurs with sharp inclinations, their blood pressure drops slightly, and then sets at an even lower level. Soon, compensatory reactions weaken sharply and blood pressure continues to fall rapidly.

This type of syncope is possible with primary insufficiency of the autonomic nervous system, family autonomic dysfunctions.

At least three syndromes of orthostatic syncope have been described:

I. Acute or subacute autonomic dysfunction. With this disease, in practically healthy adults or children, a partial or complete disruption of the activity of the parasympathetic and sympathetic systems occurs within a few days or weeks. Pupillary reactions disappear, lacrimation, salivation and sweating stop, impotence, paresis of the bladder and intestines, orthostatic hypotension are observed. Additional studies reveal an increased protein content in the cerebrospinal fluid, degeneration of unmyelinated autonomic nerve fibers. It is believed that this disease is a variant of acute idiopathic polyneuritis, similar to Landry-Guillain-Barré syndrome.

II. Chronic insufficiency of postganglionic autonomic nerve fibers. This disease develops in people of middle and older age, who gradually develop chronic orthostatic hypotension, sometimes in combination with impotence and dysfunction of the pelvic organs. After staying in an upright position for 5-10 minutes, blood pressure decreases by at least 35 mm Hg. Art., pulse pressure decreases, while pallor, nausea and increased pulse rate are not observed. Men get sick more often than women. The condition is relatively benign and apparently irreversible.

III. Chronic insufficiency of preganglionic autonomic nerve fibers. In this disease, orthostatic hypotension, along with recurrent anhidrosis, impotence, and dysfunction of the pelvic organs, is combined with lesions of the central nervous system.
These include:
1. Shy-Drager Syndrome characterized by tremor, extrapyramidal rigidity and amnesia;
2. Progressive cerebellar degeneration, some varieties of which are family;
3. More variable extrapyramidal and cerebellar diseases(striato-nigral degeneration).

These syndromes lead to disability and often death within a few years.

Secondary orthostatic hypotension results from
disorders of the autonomic nervous system
age-related physiological changes
adrenal insufficiency
hypovolemia
taking certain drugs (hypotensive drugs, tricyclic antidepressants, levodopa drugs, neuroleptics, -blockers), especially in elderly patients who have to take several drugs at the same time
Insufficiency of the autonomic nervous system - damage to pre- and postganglionic autonomic fibers - most often occurs when the lateral columns of the spinal cord (syringomyelia) or peripheral nerves are involved in the pathological process (diabetic, alcoholic, amyloid polyneuropathy, Adie's syndrome, hypovitaminosis, etc.)
orthostatic hypotension is considered one of the manifestations of Parkinson's disease,
multisystem atrophy of the brain
subclavian artery steal syndrome
But more often the causes of orthostatic hypotension are starvation, anemia, prolonged bed rest.

Situational syncope

Situational syncope occurs with coughing, urinating, defecation, and swallowing. Fainting during urination or defecation is a condition commonly seen in older people during or after urination, especially after a sudden transition from a horizontal to an upright position. It can be distinguished as a separate type of postural syncope.

It is assumed that the decrease in intravesicular pressure causes rapid vasodilation, which increases in the upright position. A certain role is also played by bradycardia, due to the activity of the vagus nerve. Fainting when coughing and swallowing is quite rare and develops only when exposed to a provoking factor specific to each form.

Syncope of a psychogenic nature
The psychogenic nature of syncope is detected in patients after possible studies in the absence of signs of heart disease or neurological disorders.

This group of patients can be divided into two categories:
patients who have had a first episode of syncope (further examination may be discontinued), and
patients who continue to worry about fainting (an assessment of the mental state of the patient should be carried out). In almost 25% of such cases, a psychiatric examination can detect mental disorders combined with fainting.

Often, emotionally labile people develop against the background of the action of a psychotraumatic factor. panic attacks, which are characterized by a sudden onset, palpitations, a feeling of heat, lack of air, then pain in the chest, trembling, a sense of fear and doom join. Hyperventilation is followed by paresthesias. At such moments, patients subjectively feel a loss of consciousness or even the onset of death, but there is no loss of consciousness or a fall. Conversation with eyewitnesses of seizures, the test with hyperventilation and the appearance of the above symptoms help the clinician to correctly diagnose.

Separately, it is necessary to describe non-epileptic seizures, or pseudo-seizures. They are more common in women around the age of 20, in whose family history, as a rule, there are references to relatives who suffered from epilepsy. Such patients had the opportunity to observe the development of epileptic seizures, imitate them, or suffer from mental illness themselves. Pseudo-seizures are varied and last longer than true epileptic seizures. They are characterized by poor coordination of movements, complex localization, occur in crowded places, injuries are very rare. During a seizure, the patient may resist seeing a doctor.

Neurological syncope

In addition to syncope of cardiac origin, syncope includes conditions with a sudden onset of short-term impairment of consciousness, which may be the result of transient anemia of the brain. A sufficient level of blood supply to the brain depends on a number of physiological conditions of the state of cardiac activity and vascular tone, the volume of circulating blood and its physicochemical composition.

There are three main factors contributing to the deterioration of cerebral blood flow, malnutrition of the brain and, ultimately, episodic blackouts.
1. Cardiac- weakening of the force of contractions of the heart of a neurogenic nature or due to acute functional insufficiency of the heart muscle, valvular apparatus, cardiac arrhythmias.
2. Vascular- a drop in vascular tone of the arterial or venous systems, accompanied by a significant decrease in blood pressure.
3. Homeostatic- a change in the qualitative composition of the blood, especially a decrease in the content of sugar, carbon dioxide, oxygen.

When selecting patients for a neurological examination, it is necessary to carefully collect a neurological history (find out the presence of seizures in the past, prolonged loss of consciousness, diplopia, headache, ask about the state after loss of consciousness) and conduct a targeted physical examination, revealing vascular murmurs and focal neurological symptoms.

The survey should also include
electroencephalography
computed and magnetic resonance imaging of the brain
transcranial dopplerography in case of suspected presence of a stenosing process (in people over 45 years of age, in case of detection of noise over the carotid artery, in persons who have had transient ischemic attacks or stroke).

Fainting in the elderly

(!!!) With the development of syncope in elderly patients, first of all, you need to think about the appearance of a complete transverse blockade of conduction or tachyarrhythmia. When examining them, it is necessary to remember the complex nature of syncope and the fact that such patients often take several drugs at the same time.

In older age, the most common causes of syncope are
orthostatic hypotension
neurological disorders
arrhythmias

If the examination revealed orthostatic hypotension, it is necessary to pay special attention to the patient's admission medicines, contributing to a decrease in blood pressure with the development of postural disorders. If the patient does not take such drugs, then the main attention should be paid to studies of the cardiovascular and nervous systems. If, during a neurological examination, there are no pathological changes, but there are complaints of impaired urination, sweating, constipation, impotence, and the patient talks about the development of fainting only after getting out of bed abruptly or after sleep, then the development chronic vegetative insufficiency. In this case, the main danger for the patient is not the loss of consciousness itself, but the accompanying fall, since this often leads to fractures.

The patient should be advised not to get out of bed abruptly, first sit down or make several movements with the legs lying down, use elastic bandages and bandages, lay carpets in the bathroom and corridor, as these are the most common places for falls due to fainting in the elderly. It is advisable to take walks in the fresh air in places where there is no hard surface, you should not stand still for a long time.

If, during a neurological examination of the patient, signs of damage to the nervous system are revealed, a more thorough examination in a specialized hospital is necessary to clarify the cause of syncope and select an adequate treatment regimen.

Syncope (syncope) is fainting. A short-term loss of consciousness is provoked by sharp failures in the cardiovascular system. The brain does not have enough blood, breathing becomes difficult, muscle tone drops to zero and the person falls down.

According to statistics, half of the adult population has experienced syncope once. Only 3.5% go to the doctor. The reason for the visit to the medical facility is more likely the injuries received during the fall. 3% of emergency surgery patients complained of recurrent seizures. Special studies have found undiagnosed syncope in 60% of adult subjects.

Syncope can occur in young people of both sexes aged 17-32 years. Any healthy person in extreme conditions for him can fall unconscious, since the physiological capabilities have their limit of adaptation.

Classification of syncope, ICD code 10

Syncope, what it is and what types it is divided into, was determined by the European Community of Cardiology.

In ICD-10, syncope and collapse are grouped under the code R55.

Stages of state development

Doctors divide fainting into 3 stages:

1. Prodromal with previous features;
2. Loss of consciousness and stability (fall);
3. post-syncope state.

Causes of fainting

When conducting clinical studies, cardiologists, neurologists, and other specialists could not determine the true cause of fainting and its relapses in 26% of subjects. A similar picture develops in practice, which makes it difficult to choose a treatment.

This is due to both the episodic precedents and the variety of triggers:

• diseases of the heart, blood vessels;
• acute short-term decrease in blood flow to the brain;
• increased excitability of the vagus nerve, which controls the muscles of the respiratory, speech, cardiac, digestive apparatus;
• arrhythmia of the heart;
• decrease in glucose levels in the bloodstream;
• damage to the glossopharyngeal nerve;
• infectious diseases;
• psychical deviations;
• hysterical fits;
• head injury;
• fatigue;
• hunger.

This is just part of a long list of possible causes of syncope.

Vasodepressor syncopation

Syncope, what it is in simple terms: a vaso is a blood vessel, a depressor is a nerve that reduces pressure. The term vasodepressor is similar to vasovagal, where the second part of the word specifies that the nerve is vagus. It travels from the skull to the intestines and can suddenly redistribute blood flow to the intestinal vessels, impoverishing the brain.

This occurs against the background of an emotional or painful peak, eating, prolonged standing or lying, fatigue from noisy crowds.

Prodromal symptoms may include weakness, crampy abdominal pain, and nausea. They last up to 30 minutes. During a short-term loss of consciousness, the postural muscle tone sharply decreases, maintaining a certain position of the body in space.

Risk factors for a tendency to vasodepressor (vasovagal) conditions:

• dosed blood loss, for example, in donors;
• low hemoglobin level;
• general hyperthermia (fever);
• heart diseases.

Orthostatic condition

Hypotension in a straight (ortho) immobile position can develop from mild weakness to severe collapse, when a person's life hangs in the balance.

When getting up from bed, exhausting standing, prodromal symptoms are expressed:

• rapid increase in muscle impotence;
• blurred vision;
• dizziness with loss of coordination, feeling of falling through the legs and body;
• perspiration, chilliness;
• nausea;
• a feeling of longing;
• sometimes palpitations.

The average degree of hypotension is recognized by:

• wet cold extremities, face, neck;
• increased pallor;
• blackout for a few seconds, urination;
• weak, slow pulse.

A heavier, more prolonged collapse is accompanied by:

• shallow breathing;
• unconscious urination;
• convulsions;
• cyanotic pallor with red-blue "marble" streaks on cold integuments.

If in the first 2 cases a person manages to sit down, lean on, then with a severe degree, he immediately falls and gets injured.

Causes of orthostatic condition:

• neuropathy;
• syndromes of Bradbury-Eggleston, Shy-Drager, Riley-Day, Parkinson.
• taking diuretics, nitrates, antidepressants, barbiturates, calcium antagonists;
• severe varicose veins;
• heart attack, cardiomyopathy, heart failure;
• infections;
• anemia;
• dehydration;
• adrenal tumor;
• binge eating;
• tight clothes.

Hyperventilating

Syncope, what it is with uncontrolled acceleration and deepening of breathing:

• occurs during anxiety, fear, panic;
• second fainting is preceded by a decrease in heart rate from 60 to 30-20 beats per minute, fever in the head, arrhythmia;
• develops against the background of hypoglycemia, pain peaks.

There are 2 variants of hyperventilatory syncope - hypocapnic (decrease in the level of carbon dioxide in the blood) and vasodepressor.

Sinocarotid syncope

The carotid sinus is a reflexogenic zone in front of the place where the carotid artery diverges into the internal and external channels. Since the sinus controls blood pressure, its hypersensitivity leads to dysfunctions of the heartbeat, tone of peripheral, cerebral vessels, which can result in fainting.

Syncope of this nature is more common in men in the second half of life and is associated with irritation of the carotid-sinus zone by tilting the head back when cutting, shaving, looking at an object above the head; squeezing collar, tie, tumor formation.

Prodromal symptoms are absent or briefly manifested by tightness in the throat and chest, shortness of breath, fear. A seizure lasting up to 1 minute. may be convulsive. After the patients sometimes complain of psychological depression.

cough syncope

Syncope when coughing can be experienced by men over 40 years old, mostly heavy smokers who choke on a cough. The risk group includes heavily coughing, broad-chested, with signs of obesity lovers to eat, take alcohol.

Fainting can be triggered by bronchitis, asthma, laryngitis, whooping cough, emphysema (pathological distension), cardiopulmonary diseases that cause bouts of hacking cough until blue and swelling of the veins in the neck. Syncope lasts from 2 s to 3 min. The patient is covered with sweat, the face is filled with cyanosis, sometimes the body twitches.

When swallowing

What is the mechanism of syncope of the swallowing type remains a mystery. Perhaps this is an excessive irritation of the vagus nerve by movements of the larynx, which responds to the work of the heart, or an increased sensitivity of the brain and cardiovascular structures to valgus influence.

Provoking factors include diseases of the esophagus, larynx, heart, lungs; stretching, tissue irritation during bronchoscopy (probe examination), tracheal intubation (introduction of a tubular dilator to restore breathing).

Swallowing syncope is manifested either as part of gastrointestinal pathologies, or in the case of heart disease (angina pectoris, heart attack), in the treatment of which digitalis preparations are used. But it also happens in healthy people.

Nicturic syncope

Syncope during urination, as well as during defecation, is more typical for men over 40 years of age. A brief loss of consciousness, occasionally with convulsions, is possible after going to the toilet at night, in the morning, sometimes during natural acts. There are practically no harbingers and consequences of fainting, a trail of anxiety remains.

There are many hypotheses about the cause-and-effect relationships of a sharp decrease in pressure:

• the release of the bladder, intestines, the contents of which pressed on the vessels, while the activity of the vagus nerve increased;
• straining with breath holding;
• orthostatic effect after standing up;
• alcohol poisoning;
• increased sensitivity of the carotid sinus;
• consequences of traumatic brain injury;
• weakness after somatic diseases.

Doctors agree that nicturic syncope occurs when a combination of negative factors occurs.

Neuralgia of the glossopharyngeal nerve

In persons over 50 years of age, the process of absorption of food, yawning, conversation is suddenly interrupted by an unbearable burning sensation in the region of the root of the tongue, tonsils, and soft palate. In some situations, it is projected into the neck, the joint of the lower jaw. After 20 s, 3 min. the pain disappears, but the person briefly loses consciousness, sometimes convulsions run through the body.

Massage or manipulations in the area of ​​hypersensitive carotid sinus, external ear canal, nasopharyngeal mucosa can lead to neuralgic syncope. To avoid this, drugs based on atropine are used. 2 types of neuralgic syncope were recorded - vasodepressor, cardioinhibitory (during inhibition of the heart).

Hypoglycemic syncope

Lowering the blood sugar level to 3.5 mmol / l already causes poor health. When this indicator falls below 1.65 mmol / l, the patient loses consciousness, and the EEG shows the attenuation of the electrical signals of the brain, which is equivalent to a violation of tissue respiration due to a lack of blood with oxygen.

The clinical picture of sugar deficiency syncope combines hypoglycemic and vasodepressor causes.

The provoking factors are:

• diabetes;
• congenital antagonism to fructose;
• benign and malignant tumors;
• hyperinsulinism (high insulin levels with low sugar concentrations) or fluctuations in sugar levels due to impaired functions of the hypothalamus, a part of the brain that provides internal stability.

Hysterical syncopation

Nervous attacks often occur in people with a hysterical, egocentric character, who by all means seek to attract the attention of others, up to the demonstration of suicidal intentions.

One of the tricks to become a central figure, win a conflict or get what you want is a tantrum with a pseudo faint. But if the egocentric often exploits such an effect, there is a danger that the next swoon will be real.

Difference of pseudoskincope:

• skin, lips of normal color;
• pulse without signs of bradycardia and frequency fluctuations;
• BP values ​​are not low.

If the "patient" groans, shudders, this indicates the presence of consciousness. He comes out of the fit fresh, while those around him are frightened.

Somatogenic

Diseases or disturbances in the activity of organs and systems, leading to oxygen starvation of the brain, become the causes of syncope of somatogenic genesis.

In the list of such pathologies:

• diseases of the heart, blood vessels;
• changes in blood composition;
• insufficiency of the kidneys, liver, lungs;
• tumors;
• bronchial asthma;
• diabetes;
• infections;
• intoxication;
• starvation;
• anemia.

Unclear etiology

Syncope, what it is in a single episode, is extremely difficult to determine. A hardware examination by exclusion allows identifying the cause of fainting in a maximum of half of those who seek medical help. The remaining cases are attributed to the sphere of influence of the vagus nerve.

Syncope drowning

Doctors do not recommend jumping into cold water, because there is a danger of a terminal state - drowning, but not from filling the lungs with water, but due to a coronary attack, blocking cerebral circulation. If the victim is pulled out of the water in time (no later than 5-6 minutes), he can be resuscitated.

Symptoms

It is necessary to distinguish between short-term fainting and prolonged loss of consciousness. If a person does not wake up for more than 5 minutes, this suggests, for example, a stroke from a rupture of a vessel or a blood clot. The patient may slowly, with amnesia, come to his senses, or may fall into a coma.

If the attack lasts 1-2 minutes. - this is a slight fainting, up to 3 minutes. - heavy.

Symptoms of fainting are systematized as follows:

1. Previous Signals: weakness, dizziness; flies, trembling mesh, or darkening of the eyes; noise, ringing, squeaking in the ears; cottoniness in the limbs;
2. Syncope: sharp blanching; wandering unconscious gaze or closed eyes; the pupils are initially constricted, dilate, not responding to light stimuli; the body goes limp and falls; the limbs become cold, cold sticky sweat over the entire area of ​​\u200b\u200bthe integument; the pulse is weak or not palpable; breathing is shallow, reduced;
3. post-syncope: rapid return of consciousness (if the cardiovascular apparatus is normal and there is no damage during the fall); restoration of blood circulation, normal breathing, heart rate, color of integument; disappearing after a few hours weakness, malaise.

Diagnostics

The diagnostic program includes:

• compiling an anamnesis on the frequency and nature of seizures, past diseases, taking medications;
• radiography of the heart, lungs, skull;
• ECG, EEG;
• assessment of noises, heart sounds by phonocardiography - sensors and sound amplifiers;
• blood tests, urine;
• massage pressure on the carotid sinus (10 s);
• oculist consultation.

If necessary, computed layer-by-layer tomography of the heart, blood vessels, and brain is prescribed.

First aid for syncope

With the appearance of characteristic precursors of fainting, you need to lie flat and raise your legs. This will ensure blood flow to the heart, head. Unfasten clothing that restricts the chest, massage the point above the upper lip, temples.

In case of loss of consciousness before the arrival of doctors, others help by such actions:

• pick up a limp person;
• lay flat, raise the legs, turn the head on its side so that the tongue does not block the access of air;
• open windows, turn on the fan, free the sternum from clothes;
• give ammonia to smell, slap on the cheeks, splash with cold water, rub the ears.

Methods of treatment and protocol for managing patients

Therapy of syncope is selected individually in accordance with the underlying cause and symptoms.

In most cases, the patient is prescribed between attacks:

• nootropic drugs that improve brain function, their resistance to stress, hypoxia;
• adaptogens that tonic the central nervous system, and through it the whole body;
• venotonics;
• vagolytics blocking the vagus nerve;
• antispasmodics;
• sedatives;
• vitamins.

The protocol of patient management provides for the treatment of causative and concomitant pathologies. In difficult cases resort to surgery. If it is not possible to remove excessive excitation of the vagus nerve with cholinergic and sympathicolytics, electrophoresis for novocaine blockade, X-ray therapy, the suppression of nerve fibers is performed.

Vegetative disorders are corrected by periarterial exfoliation - removal of a part of the outer shell of the artery, which prevents its expansion. Cardiopathology of the carotid sinus is eliminated by the implantation of pacemakers.

Complications

Fainting is dangerous with severe bruises, blows on sharp objects. Syncope can end tragically in patients with impaired cardiovascular and cerebral activity. There is a risk of developing chronic hypoxia, deterioration of intellectual abilities, coordination.

Prevention

Syncope can be avoided by avoiding triggers such as heat, sudden movements, tight clothing, high pillow beds, crowded places. Mild hypotension can be neutralized by walking, rocking from toe to heel, kneading muscles, and deep breathing. Patients with hypertension need to reduce the dosage of vasodilators.

With vasovagal, orthostatic syncope, you will need things, stockings, dragging the lower part of the body and lower limbs.

Since the treatment of the elderly, the elderly is difficult due to contraindications, it is necessary to free their rooms from sharp-angled objects, put a soft covering on the floor, and provide accompaniment on walks.

The prognosis of syncope depends on timely medical care. Subject to this condition and the right lifestyle, there is a chance to forget what fainting is.

Article formatting: Lozinsky Oleg

Syncopation video

First aid for fainting:

Reasons for the loss of creation:

In healthy people slowing of the ventricular rate, but not less than 35-40 beats per minute, and its increase, but not more than 180 beats per minute, does not cause a decrease in cerebral blood flow, especially when a person is in a horizontal position. Changes in heart rate beyond the above values ​​can cause cerebrovascular accident and disruption of brain activity. Resistance to changes in pulse rate decreases in a person who is in a vertical position, with cerebrovascular diseases, anemia, lesions of the coronary vessels, myocardium, and heart valves.

Complete atrioventricular block. Syncope attacks in combination with this pathology are called the Morgagni-Adams-Stokes syndrome. Morgagni-Adams-Stokes attacks usually occur in the form of an instant attack of weakness. The patient suddenly loses consciousness, after asystole lasting for several seconds, he turns pale, loses consciousness, clonic convulsions may develop. With a longer period of asystole, the skin color turns from ash-gray to cyanotic, fixed pupils, urinary and fecal incontinence, bilateral Babinsky's symptom. Some patients may subsequently experience long-term confusion and neurological symptoms due to cerebral ischemia, and persistent mental impairment may also develop, although focal neurological symptoms are rarely noted. Similar cardiac syncope can be repeated several times a day.

In patients with similar bouts of blockade may be permanent or transient. It is often preceded or later by conduction disturbances in one or two of the three bundles that normally activate the ventricles, as well as second-degree atrioventricular block (Mobitz II, bi- or trifascicular blocks). If there is a complete blockade and the pacemaker below the blockade does not function, fainting occurs. A brief episode of tachycardia or ventricular fibrillation can also lead to fainting. Repeated syncope with ventricular fibrillation is described, characterized by a prolongation of the Q-T interval (sometimes in combination with congenital deafness), this pathology may be familial or occur sporadically.

less often fainting occurs when the sinus rhythm of the heart is disturbed. Repeated episodes of tachyarrhythmias, including atrial flutter and paroxysmal atrial and ventricular tachycardias with intact atrioventricular conduction, can also dramatically reduce cardiac output and, as a result, cause syncope.

With another variety cardiac syncope heart block occurs reflexively due to excitation of the vagus nerve. Similar phenomena were observed in patients with esophageal diverticula, mediastinal tumors, lesions of the gallbladder, carotid sinus, glossopharyngeal neuralgia, irritation of the pleura or lung. However, with this pathology, reflex tachycardia is more often of the sinus-atrial type than of the atrioventricular type.
Features of the onset of an attack can help in diagnosing the causes that cause fainting.

When an attack develops within seconds, carotid sinus syncope, postural hypotension, acute atrioventricular block, asystole, or ventricular fibrillation are most likely to be suspected.
With the duration of the attack more than a few minutes but less than an hour, it is preferable to think of hypoglycemia or hyperventilation.

Syncope development during or immediately after exertion suggests aortic stenosis, idiopathic hypertrophic subaortic stenosis, marked bradycardia, or, in the elderly, postural hypotension. Sometimes syncope that occurs with stress is observed in patients with aortic valve insufficiency and gross occlusive lesions of the arteries of the brain.

In patients with asystole or fibrillation ventricular loss of consciousness occurs within a few seconds, then often there are short-term clonic muscle cramps.

In older people, suddenly, without visible causes of fainting makes one suspect a complete heart block, even when no changes are found on examination of the patient.
fainting that occur with convulsive activity, but without significant changes in hemodynamic parameters, are presumably epileptic.

In a patient with a feeling of weakness or fainting accompanied by bradycardia, neurogenic seizures should be distinguished from cardiogenic (Morgagni-Adams-Stokes). In such cases, the ECG is of decisive importance, but even in its absence, the clinical signs of the Morgagni-Adams-Stokes syndrome can be noted. They are characterized by a longer duration, a constantly slow heart rate, the presence of murmurs synchronous with atrial contractions and atrial contraction waves (A) during jugular vein pulsation, as well as a changing intensity of the first tone, despite a regular heart rhythm.
The problem of differential diagnosing the causes of fainting is still relevant.

First of all, you need to exclude or confirm such emergencies, in which the first fainting state can become a leading symptom: massive internal bleeding, myocardial infarction (which can occur in a painless form), acute heart rhythm disturbances.
Repeated fainting require a different approach to identifying the causes leading to it.

Causes of repeated bouts of weakness and disturbances of consciousness can be the following:

I. Hemodynamic (decreased cerebral blood flow)
A. Inadequate mechanisms of vasoconstriction:
1. Vasovagal (vasodilating).
2. Postural hypotension.
3. Primary insufficiency of the autonomic nervous system.
4. Sympathectomy (pharmacological when taking such antihypertensive drugs as alpha-methyldopa and apressin, or surgical).
5. Diseases of the central and peripheral nervous system, including autonomic nerve fibers.
6. Carotid sinus syncope. B. Hypovolemia:

1. Loss of blood due to gastrointestinal bleeding.
2. Addison's disease.

IN. Mechanical restriction of venous return:
1. Valsalva test.
2. Cough.
3. Urination.
4. Atrial myxoma, globular valvular thrombus. D. Decreased cardiac output:

1. Obstruction of the ejection of blood from the left ventricle: aortic stenosis, hypertrophic subaortic stenosis.
2. Obstruction of blood flow through the pulmonary artery: pulmonary artery stenosis, primary pulmonary hypertension, pulmonary embolism.
3. Extensive myocardial infarction with insufficiency of pumping function.
4. Cardiac tamponade.

D. Arrhythmias:
1. Bradyarrhythmias:
a) atrioventricular blockade (second and third degree) with Adams-Stokes attacks;
b) ventricular asystole;
c) sinus bradycardia, sinus-atrial blockade, cessation of activity of the sinus node, weakness syndrome of the sinus node;
d) carotid syncope;
e) neuralgia of the glossopharyngeal nerve.

2. Tachyarrhythmias:
a) periodic ventricular fibrillation in combination with bradyarrhythmias or without them;
b) ventricular tachycardia;
c) supraventricular tachycardia without atrioventricular block.

II. Other causes of weakness and periodic disturbances of consciousness

A. Changes in blood composition:
1. Hypoxia.
2. Anemia.
3. Decrease in CO2 concentration due to hyperventilation.
4. Hypoglycemia.

B. Cerebral disorders:
1. Cerebrovascular disorders:
a) circulatory failure in the pools of extracranial vessels (vertebrobasilar, carotid);
b) diffuse spasm of cerebral arterioles (hypertensive encephalopathy).

2. Emotional disorders.

In other cases, even at the present stage, the possibilities of clinical medicine do not allow establish the nature of fainting almost 26% of the time. Tests with dosed physical activity on a bicycle ergometer or treadmill are used; long passive orthostatic test. When conducting these tests, they distinguish:
Cardioinhibitory vasovagal syncope - development at the time of an attack of arterial hypotension (a decrease in systolic pressure below 80 mm Hg) and bradycardia with a heart rate of less than 40 beats / min.
Vasodepressor vasovagal syncope - arterial hypotension with changes in heart rate within 10% compared with the indicators observed during the development of syncope.
Vasovagal syncope of mixed type - arterial hypotension and bradycardia. At the same time, bradycardia in terms of values ​​could be absolute (less than 60 per minute) or relative compared to the heart rate before the attack.