Fainting or syncope occurs when insufficient oxygen reaches the brain. A person can either suddenly lose consciousness without warning or may develop symptoms before hand such as feeling light headed, sweaty or nauseous. The person then falls unconscious and in most cases after a few moments recovers and may feel nauseous or can vomit.

Treatment:

The best position for fainting is lying down. Often a person who has fainted ends up on the floor and this helps to improve oxygen supply to the brain. Leave the person in the recovery position and do some basic checks. You should check that the person is breathing and there is a pulse.

After a simple faint a person should wake up without any deficit but there are other reasons why a person can faint (have syncope) and the person may remain unconscious or have difficulties when recovered. This depends on the cause.

Causes of Syncope.

Vasovagal Syncope: This is due to an over stimulation of the Vagus Nerve. This results in heart slowing down and less blood reaching the brain. This can result from

1. Severe pain or fear. A fellow Medical Student fainted when I tried to take a drop of blood from his finger by pin prick.

2. Acute Blood loss. This can be a haemorrhage or serous loss from burns.

3. Postural Hypotension. Blood Pressure drops when standing up quickly.

4. Drugs. Some drugs such as nitrates can do this.

Cardiac Cause:

1. Asystole: More commonly know as Flatline. No cardiac output.

2. Sudden irregular heart beat such as ventricular fibrillation.

3. Aortic Stenosis. When the valve allowing flow of blood to the Aorta from the heart is restricted. Increase effort may produce syncope.

4. Cardiac Shock: This can occur after a massive Infarct (heart attack).

5. Pulmonary Embolism. This is a clot in the lungs.

6. Myocardial Infarction.
   

State of the Blood:

1. Hypoxia: Low level of oxygen in the blood either due to low percentage of oxygen in the lungs or poor transfer of oxygen from the lungs to the circulation.

2. Anaemia: Low Haemoglobin level means less oxygen can be transported from the lungs to other parts of the body.

3. Hypoglycaemia: This is low blood sugars level. Glucose is needed to produce energy in the body. In the presence of oxygen, glucose is broken down to release energy.

Cerebral problems.

1. Ischaemic attacks: This is when blood supply is temporarily restricted. This is often due to clogged up arteries supplying the brain. Commonly know as Vertebro-Basilar Insufficiency.

2. Stroke: This can be cerebral thrombosis (clot) or Cerebral Haemorrhage (bleed).

What to look for when deciding cause:

1. May be just a simple faint with sweating, pallor and desire to pass urine.

2. Epilepsy. May have obvious pattern of a seizure.

3. May be following a bout of cough. Cough Syncope.

4. May be following Meniere’s Disease. This is a disease of the ears causing vertigo, nausea or even vomiting.

5. Hysteria.

If you see a person who you suspect has fainted, put the person in a recovery position and keep checking the stats e.g. pulse and breathing while you wait for assistance or the person recovers.

Your heart is made up of two ventricles and two atria. There is a left and right side of the heart. The left side pumps oxygenated blood to the rest of the body. The right side collects deoxygenated blood from the veins and sends it to the lungs and then returns it to the left heart.

If your heart rate is regular and normal, it is estimated it will beat 2700 million times by the age of 75 years.  So look after this precious organ. Coronary Artery Disease is the commonest cause of death in UK. There are several things you can do to avoid heart disease. This Blog will go through them all.

Blood pressure.:Low blood pressure will make you light headed when you stand up quickly. You can become dizzy or even pass out. High blood pressure can cause heart disease and conditions such as stroke. It is therefore important that you have your blood pressure checked. If  high then you may need medication.

High blood pressure or hypertension is a chronic condition and you should be prepared to be on medication for the rest of your life. The gold standard for blood pressure is 120/80 and 140/90 and above will need scrutiny. Your blood pressure increases with age as the arteries become less elastic. Statistics show that men are at a higher risk of developing high blood pressure in their 30s and early 40s but the risk equalises between 44 and 55 and after that, women have a greater risk.

Research show that alcohol in moderation is beneficial to the heart. This is because it increases the level of the good high-density cholesterol (HDL). It also makes the blood less sticky reducing the risk of stroke and heart attacks.

Smoking affect the heart and giving up smoking reduces your risk of coronary artery disease by 36%. Childhood obesity is an good indicator of later in life heart disease. The statistic show that between the ages of five and 17  years, one in ten are obese ~ approximately 155 million globally. A bit scary.

Genetic factors must be taken into considering when assessing risk and this can be as high as 50%. In addition a person who has coronary event or stroke is a greater risk of having further problems and preventative medication are given.

Heart failure is a serious disease and results in fluid leaving the circulation and diffusing into tissues of the body. This leads to swelling of the legs, back etc. Shortness of breath on exertion or at rest can be due to fluid in the lungs. At rest a person with heart failure needs to be propped up with several pillows to avoid breathlessness. There can be fatigue, light headedness, weight gain due to fluid retention or even chest pain.

Coffee contains caffeine. This can increase the heart rate or even make the heart skip a beat. Caffeine is also found in tea and chocolate. If you have a healthy heart this is not a problem , but if you have coronary heart disease it is best to cut out coffee.

Dr. Phil Hariram.

This is a sudden cessation of effective pumping of the heart.

Check for breathing and feel for a pulse.

Causes.

Cardiac arrest is nearly always due to Acute Coronary Insufficiency. This is insufficient supply of blood to the heart and can result from Myocardial Infarct (Heart Attack) or severe generalised blockage to the coronary arteries.

Signs and Symptoms.

Sudden loss of consciousness.

Absence of peripheral pulses e.g. Radial Pulse.

No heart beat when examined by a doctor with a stethoscope.

Do not confuse with:

Syncope. Loss of consciousness due to shock.

Stroke: Can become unconscious.

Epileptic Attack.

Head Injury.

Unusual Psychiatric conditions such as Catatonia.

Sedative or alcohol overdose.

Hypothermia.

Investigations:

ECG will show flat line or ventricular fibrillation.

Treatment:

Speed in administering treatment is vital and will save lives.

A thump on the chest over the heart may restore normal rhythm.

Get someone to call the Emergency Services.

Place patient in supine position (face up) and start cardiac massage-sharp downward movements over the chest wall at intervals of 1 second.

If you have an assistant he or she should give mouth to mouth resuscitation.

If not pause at intervals to do it yourself.

Continue until help arrives.

Dr. Phil Hariram.

Angina is a constrictive pain in the chest due to Ischaemic heart disease. It is also known as Angina pectoris.

There are two types. Stable Angina is of short duration brought on by physical exertions or mental stress. Unstable Angina is of longer duration lasting between 30 to 60 minutes and can be brought on by stress but may occur at rest e.g. at night.

What is Angina pectoris?

Angina is a pain in the chest and it is caused by a progressive obstruction of the Coronary Artery tree usually from arteriosclerosis. It can be aggravated by conditions such as anaemia, thyrotoxicosis and hypertension. It is more common is diabetics.

Signs and Symptoms.

Angina is a crushing heavy pain in the chest lasting 2 to 10 minutes. The pain is not sharp. The pain can radiate to the left arm, occasionally to the right side or into the neck or abdomen. It is triggered by increased cardiac demand from exertion, cold, heavy eating, smoking, anger and fear. If examinaed by a doctor no abnormality will be detected  but an ECG will show typical changes during an angina attack.

Diagnosis.

This is usually from a careful history and where the pain presents and where it spreads to. A provocative ECG (Exercise ECG) using a threadmill or exercise bike will display characteristic changes. Cardiac Angiography will hone in on the specific site and distribution of the Coronary Artery.

Some times Angina symptoms can be confused with symptoms of anxiety, indigestion, peptic ulcer, oesophageal spasm, hiatus hernia, gall bladder disease, pleurisy and pancreatitis.

If you suspect you have angina, it is vitally important that you seek medical help at the earliest opportunity. Treatment today is excellent.

There are some general measures you must adopt. You should stop smoking. Lose weight if indicated. Have you blood pressure checked and if high and you are on medication, not only must you take your tablets but have regular BP checks to ensure good BP control. If you are anaemic or your cholesterol is high, you will be given treatment by your GP.

If you have chest pains and you are not sure, check it out. See your GP. Either way it is better to know. Reassurance from your GP goes a long way and if it is heart related, you have started the process of investigation and treatment.

Dr. Phil Hariram.