Fainting also known as Syncope of "black out" is defined as a
condition of sudden loss of consciousness followed by the return to full
wakefulness in a short duration as a result of abnormally low blood
pressure. In most cases, it is caused by hypotension, with blood
pressure that's lower than 90/60 mmHg.(1). Even though Low blood pressure
has mainly been regarded as good health for people who exercise, but
recent studies have indicated an association with depression in elderly
people. there are epidemiological evidence for an association of low blood pressure
with anxiety and depression, which is not caused by cardiovascular
disease.(2). In some case, severely low blood pressure can seriously
impair
adequate blood flow to vital organs and a life-threatening condition
called shock.
Treatments
A. In conventional medicine perspective
1. Prehospital Care(60)
Acute care to someone faint must be taken to increase blood flow to the
brain, such as with the legs raise, loosen all tight
clothing, crossing the legs or squeezing the thighs together, etc. and
call 911. The patient may require the below from the medical team.
b. Oxygen administration
c. Advanced airway techniques
d. Glucose administration
e. Pharmacologic circulatory support
f. Pharmacologic or mechanical restraints
g. Defibrillation or temporary pacing
h. Etc
2. Medication
2.1. Beta blockers
a. Beta blockers or beta-adrenergic blocking agents,
beta-adrenergic antagonists, beta-adrenoreceptor antagonists or beta
antagonists are the most commonly used type of medication to prevent
syncope, as a result of blunting of elevated catecholamine levels that
precede vasovagal syncope. Dr. John R. Kapoor, MD, PhD at the Stanford
University said "Notwithstanding the widespread use of beta-blockers in
the past, some studies on chronic beta-blocker use have been less than
encouraging and may suggest some benefit in older but not in younger
patients, as mentioned in the recent article by Tan and Parry"(61). In
other study group consisted of 62 patients (29 females, mean age
32.8+/-12.3
years and 33 males, mean age 35.9+/-18.2 years) with at least two
syncopal episodes during the six months preceding positive tilt testing,
propranolol administered intravenously prevents syncope
during tilt testing in a significant proportion of patients. Both
complete or partial efficacy of intravenous propranolol predict
long-term efficacy of chronic beta blocker therapy in patients with vaso-vagal syncope.(62)
b. Side effects
Major cardiac effects caused by beta blockade include the precipitation
or worsening of congestive heart failure, and significant negative
chronotropy(62a) and severe and therapy-resistant rhinitis, sinusitis, and nasal polyp(62b)
and (62c)
* Nausea
* Diarrhea
* Bronchospasm
* Dyspnea
* Cold extremities
* Dizziness
* Hair loss
* Abnormal vision
* Insomnia
* Nightmares
* Sexual dysfunction
* Erectile dysfunction
* Etc.
2.2. Serotonin re-uptake inhibitor (SSRI)
a Antidepressants are commonly used in the treatment of
depression, anxiety disorders, and some personality disorders. In the
study to assess whether the well-tolerated serotonin re-uptake inhibitor paroxetine hydrochloride could prevent vasovagal syncope
in young patients resistant to or intolerant of previous traditional
therapies, Paroxetine significantly improved symptoms of young patients
with recurrent vasovagal syncope
unresponsive to or intolerant of traditional medications and was well
tolerated by patients.(63). Other report indicated that the serotonin reuptake inhibitor sertraline hydrochloride can be effective in preventing recurrent neurocardiogenic syncope in selected patients unresponsive to or intolerant of other therapeutic modalities.(64)
b. Side effects (65)
Almost all SSRIs are known to cause one or more of these symptoms,
including Sexual Dysfunction(66) and withdrawal syndrome(67), Suicide
risk(68) and
* Nausea/vomiting
* Drowsiness or somnolence
* Headache (very common as a short-term side effect)
* Bruxism
*Tinnitus
* Extremely vivid or strange dreams
* Dizziness
* Fatigue
* Mydriasis (pupil dilation)
* Urinary retention
* Changes in appetite
* Insomnia
* Etc.
In rare case, SSRI antidepressants may cause cardiac effects, according to American Family Physician,
8/1/97
by Grace Brooke Huffman, but SSRIs are safe
and do not have a high rate of cardiovascular adverse events. However,
further study is needed to determine whether tricyclic antidepressants
and SSRIs are equally efficacious in patients with cardiovascular
disease.(69)
3. Surgical
Pacemaker implantation may be necessary for some patient because of
either severity or do not respond to the medication to has been
successful in decreasing the number of fainting episodes. Pacemaker
implantation is a procedure to put a small battery-operated device into
the chest to help the heart beating regularlyas it send out the regular
electrical pulses. There is a report on a patient with recurrent sleep syncope (with physical injury) in whom an asystolic pause was documented during one of her "sleep syncope" spells. Implantation of a dual chamber pacemaker (5-year follow-up) "cured" her of further syncope(70)
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Sources
(1) http://www.nhlbi.nih.gov/health/dci/Diseases/hyp/hyp_whatis.html
(2) http://www.ncbi.nlm.nih.gov/pubmed/17183016
(62) http://www.ncbi.nlm.nih.gov/pubmed/14560324
(62a) http://www.uptodate.com/contents/major-side-effects-of-beta-blockers
(62b) http://www.ncbi.nlm.nih.gov/pubmed/7992269
(62c) http://en.wikipedia.org/wiki/Beta_blocker#Adverse_effects
(63) http://www.ncbi.nlm.nih.gov/pubmed/10687110
(64) http://www.ncbi.nlm.nih.gov/pubmed/8034887
(65) (http://en.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor)
(66) http://www.ncbi.nlm.nih.gov/pubmed/22515703
(67) http://www.ncbi.nlm.nih.gov/pubmed/21992148
(68) http://www.ncbi.nlm.nih.gov/pubmed/12668373
(69) http://the-medical-dictionary.com/bromazepam_article_8.htm
(70) http://www.ncbi.nlm.nih.gov/pubmed/22433038
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