Cardiogenic fainting can be very dangerous as it can sometimes be a symptom of a serious heart disease. Find out when to suspect cardiogenic syncope, what causes it, and how to diagnose and treat it.

Cardiogenic syncope- caused by cardiovascular disease are rare, but very dangerous. The main mechanism of cardiac syncope is a sharp drop in stroke volume, impaired stroke volume expansion, arrhythmias, or an obstruction in the outflow of blood from the heart.

Basic diagnostics is based on a medical examination, ECG, specialist should be carried out by a cardiologist and include, among others: echocardiographic examination, Holter EKG, less often invasive examination. The mainstay of treatment of cardiogenic syncope is the determination of the cause and its treatment.

Syncope is a complete loss of consciousness due to a disturbance in the blood supply to the brain, it begins abruptly and usually subsides fairly quickly. The reasons for this state are various, and due to their origin, fainting is divided into:

  • reflex
  • caused by orthostatic hypotension
  • cardiogenic
  • neurogenic

The most common are reflex fainting, they are caused, among others, by prolonged standing, high ambient temperature or emotional stress. This type of unconsciousness is not related to any specific disease and is not serious.

Cardiogenic causes are less frequent, but most often they are of organic origin, that is, they are a symptom of heart or vascular disease. Accordingly, recurrent syncope or those accompanied by symptoms described below should be diagnosed for cardiovascular disease. Correct diagnosis usually allows them to be treated and prevent future episodes.

Cardiogenic syncope: causes

Fainting occurs when the body's need for oxygen or nutrients increases, in order to meet this need, the volume of blood pumped by the heart or the heart rate must be increased. Fainting occurs if any of these mechanisms cannot work. The same is true when the requirement remains constant, but the emergency causes a reduction in blood volume or frequency being pumpedhis work.

The causes of cardiogenic syncope can be:

  • heart attack
  • arrhythmias: ventricular arrhythmias, less often atrial
  • channelopathies, or congenital defects of ion transporters, electrical diseases of the heart
  • impulse conduction disorders in the heart - atrioventricular blocks
  • impulse formation disorders in the heart sinus node
  • pulmonary embolism
  • valvular disease, especially aortic stenosis
  • hypertrophic cardiomyopathy
  • atrial myxoma - a benign tumor that disrupts the blood flow in the heart
  • pulmonary hypertension
  • myocarditis
  • congenital anomalies of the coronary arteries
  • arterial diseases, e.g. Kawasaki disease

Some of the diseases mentioned are congenital malformations, hence they are more common in children, therefore syncope in children should be diagnosed by a pediatric cardiologist. Most of the diseases listed above also have other symptoms that allow for diagnosis of cardiological diseases.

Characteristics of cardiogenic syncope

Cardiac cause of syncope is more likely if you have a history of cardiac disease (e.g. ischemic heart disease), loss of consciousness during exercise, or if you have had chest pain or palpitations.

Other factors that increase this probability are:

  • over 60
  • male gender
  • fainting in the supine position
  • or a sudden start

Moreover, the differentiation between cardiogenic and neurogenic causes is facilitated by the lack of seizures, involuntary urination and the so-called epileptic aura.

Diagnosis of cardiogenic syncope

Most cardiogenic causes of syncope are dangerous to he alth and life, and at the same time are subject to effective treatment, therefore the diagnosis of loss of consciousness focuses on searching for the causes in the circulatory system.

The diagnosis of the disease leading to syncope begins with an interview, medical examination, it is very important to measure blood pressure and perform an ECG. This diagnosis allows a preliminary assessment of the cardiovascular system and the need for immediate action.

Basic evaluation should also include laboratory tests to rule out anemia, electrolyte disturbances, or inappropriate blood glucose levels - blood sugar.

If no deviations from the norm are found in these tests, specialist tests are carried out and can be performedoutpatient.

A doctor who deals with the diagnosis and treatment of cardiogenic and reflex syncope is a cardiologist or pediatric cardiologist, in the case of neurogenic causes, a neurologist. A more detailed assessment of the loss of consciousness includes:

  • chest X-ray examination
  • echocardiographic examination to detect possible structural defects - valve defects, abnormal contractility of the heart muscle or heart tumors
  • Holter EKG, which is a continuous recording, which often allows you to assess the heart rhythm during fainting and determine whether diseases of the conductive system are the cause of syncope
  • implantation of ILR - a device that constantly monitors the electrical work of the heart, and in the event of fainting, it can be recorded and later verified by a doctor. This is useful as Holter testing is performed for 24 hours and ECGs are usually not obtained during syncope because these episodes are quite rare
  • exercise ECG test, if the loss of consciousness was related to physical activity
  • sometimes also an electrophysiological test, which allows you to accurately assess the electrical activity of the heart and the possible occurrence of dangerous arrhythmias

Extended syncope diagnostics may also include looking for causes other than typical cardiological ones, in which case the following is performed:

  • computed tomography of the head or EEG in search of neurogenic causes
  • Doppler ultrasound of carotid and vertebral arteries
  • tilt test if reflex syncope is suspected

Treatment of cardiogenic syncope

The diagnosis of heart disease as the cause of fainting requires constant care and cardiological treatment. Depending on the diagnosis, hospital treatment is implemented as a matter of urgency, in the case of:

  • heart attack - coronary angioplasty (ballooning and stenting),
  • pulmonary embolism hospital treatment and drugs that "thin the blood"
  • heart disease and tumors often require cardiac surgery

Another therapeutic option is ablation of the sites responsible for arrhythmia. In the case of sinus node disease, i.e. inadequate generation or conduction of impulses by the heart, a pacemaker must be implanted.

If the loss of consciousness was associated with cardiac arrest and a serious disturbance of the heart rhythm, such as a ventricular arrhythmia, sometimes it is necessary to implant a cardioverter-defibrillator - a special pacemaker. The same is done in the case of congenital canopathy, whichmay pose a risk of cardiac arrest.

In less serious diseases, outpatient procedures and effective pharmacological treatment are possible. The exact procedure and its mode depend on the identified cause.

First aid in case of fainting

The witness of loss of consciousness is obliged to help the sick person. First of all, you should check consciousness and breathing. If the injured person is not breathing, call for help - tel. 112 and start cardiopulmonary resuscitation: chest compressions and rescue inhalations in the scheme 30: 2. With a sustained breathing, the unconscious person lies in a safe side position, calls for help and monitors the sick person.

It is also worth providing fresh air and making breathing easier, for example by unbuttoning a shirt collar or carrying it out of a stuffy room. After regaining consciousness, it is necessary to gradually upright the injured person in the protection of third parties.

About the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

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Category:

Cardiology