What drugs are used to treat syncope?

Syncope: Causes, Symptoms & Treatment

SOS: first aid for syncope

If someone loses consciousness, action should be taken quickly. First aid is important, as is the notification of an emergency doctor.

First aid measures:

  • Check whether the person concerned reacts to being spoken to.
  • Lay the passed out on his back and raise his legs. This improves blood circulation.
  • If no breathing sounds can be heard, resuscitation measures should be undertaken immediately: start with chest compressions and perform two breaths after every 30 compressions. Keep going until the ambulance arrives.
  • If the person concerned wakes up from unconsciousness, it may be that they are still confused and insecure. Then it is helpful to talk to him and calm him down.

What is syncope?

Anyone who experiences syncope or very brief fainting usually wakes up after a few seconds. Afterwards, those affected are quickly able to orientate themselves again. The sudden loss of consciousness is accompanied by a loss of tension in the muscles. Therefore, syncope often leads to a fall. Sometimes there are also spasmodic muscle movements. Afterwards, you can usually no longer remember the attack. Syncope is not to be equated with other loss of consciousness, such as that due to epileptic seizures or circulatory disorders of the brain.

Causes of syncope

If the brain receives too little oxygen, it reacts to this and the circulatory system collapses. The reasons for the disturbed blood circulation and thus for the undersupply with blood can be varied. Different types of syncope are differentiated according to their respective cause:

  • Neurocardiogenic syncope or vasovagal syncope
  • Orthostatic syncope
  • Cardiac syncope
  • Cerebrovascular syncope

Neurocardiogenic syncope or vasovagal syncope:

This neural-mediated syncope, which occurs most frequently, usually affects healthy people. An overreaction of the nervous system causes a sudden drop in blood pressure and pulse. Common triggers are:

  • Events that provoke an overreaction of the vagus nerve (vagus nerve), such as: fear, shock, pain, extreme heat or cold, stress, noise or standing for long periods of time.
  • Build-up of strong pressure in the abdomen or chest, for example: when blowing your nose, when you press your stool or urinate violently.
  • A disorder of the autonomic nervous system: In what is known as autonomic neuropathy, syncope can also occur.
  • Carotid Sinus Syndrome: In people with carotid sinus syndrome, the receptors in the carotid artery are overly sensitive to pressure. Even small touches can cause the vessels to suddenly widen and blood pressure to drop. Syncope can occur if the brain is not supplied with enough blood. Weak pressure development, for example from shaving or a collar that is too tight, but also violent turning of the head can then lead to syncope. Older people are more likely to be affected.

Orthostatic syncope

Orthostatic syncope can occur when someone suddenly stands up from a lying position. Since the blood is evenly distributed over the body when lying down, when you stand up quickly - due to gravity - it sinks into the lower half of the body. The brain is briefly undersupplied with blood. The result is orthostatic or orthostatic syncope. The triggers include:

  • Dehydration: The risk of syncope increases with insufficient fluid intake. The circulating blood volume is reduced and the sagging of the blood when standing up becomes more noticeable in the lower part of the body.
  • Diabetic polyneuropathy (nerve damage caused by diabetes): In the long term, high blood sugar levels can damage the nerves. The autonomic nervous system can also be affected. The result is a slowing down of the reflexive contraction of the vessels when you come to a stand from lying down. Those affected can suffer from syncope.
  • A disorder of the autonomic nervous system: In so-called autonomic neuropathy, syncope can also occur.
  • Varices (varicose veins): Pathologically enlarged veins on the legs can act as an additional reservoir of fluid. As a result, when you get up from lying down, a large amount of blood sinks into your legs. This can lead to syncope.

Cardiac syncope:

Heart disease can temporarily reduce blood supply to the brain. As a result, too little oxygen and energy get there, which favors the development of cardiac syncope. The triggers include:

  • Cardiac arrhythmias: If the heart beats too slowly (bradycardia) or too fast (tachycardia), it may be that it pumps too little blood into the circulation. Because of these arrhythmias, there is not enough oxygen in the brain. Those affected can suffer a circulatory collapse.
  • Aortic valve stenosis: The narrowing of the aortic valve can also lead to syncope.
  • Hypertrophic cardiomyopathy: Anyone who suffers from this pathological thickening of the heart muscle can be affected by syncope.
  • Heart attack: Cardiac syncope can also occur with a heart attack.

Cerebrovascular syncope:

The rarely occurring cerebrovascular syncope describe so-called tapping phenomena (steal syndrome). If a vascular blockage occurs in the body and the area behind it threatens to remain unsupplied, the blood supply to another area is tapped via another vessel. Cerebrovascular syncope occurs, among other things, in:

  • Subclavian steal syndrome: The central drop in blood pressure, also in the brain, can lead to temporary dizziness, unsteady gait, visual disturbances and fainting.

Another cause of syncope can be the use of certain medications, for example for high blood pressure, cardiac arrhythmias or depression.

Syncope - when to see a doctor?

A short-term faint does not necessarily have to be due to a serious illness. Nevertheless, one should see a doctor after a syncope. Since a faint is usually accompanied by a fall, there is always a risk of injury. And if an increased potential for repetition is to be assumed, targeted therapy of the cause of the syncope should definitely be carried out. A thorough medical examination can determine whether the cause of the syncope is harmless or a symptom of a serious illness.

Syncope - diagnosis

The patient is questioned in detail by the doctor about the occurrence of the fainting. Information on current complaints, but also on previous medical history, is important. In order to get to the bottom of the cause of the syncope, the following questions are asked, among others:

  • For example, does the patient have diabetes, Parkinson's or epilepsy?
  • Are you taking any medication? Which medicines have been prescribed?
  • In what situation did the loss of consciousness occur? For example, at rest or during physical activity?
  • Was there a trigger for the collapse?
  • Could the fainting be announced by certain signs?
  • Did you experience pain before the syncope?
  • Did you experience palpitations before you passed out? Or did you get cravings?

examination

After the physical examination and the measurement of pulse and blood pressure (lying down and standing), a blood test is usually carried out. For example, a heart attack or anemia can be detected. The blood analysis also provides information about possible derailments in blood salts or metabolism. A Schellong test (standing test) is carried out to identify orthostasis problems. A tilt table test is carried out to identify any reflex syncope. The result of a carotid sinus massage provides information on a possible carotid sinus syncope:

  • If a heart disease is suspected to be the cause of the syncope, special heart diagnostics are initiated. This includes, among other things: the ECG in the event of a possible cardiac arrhythmia, more rarely a long-term ECG over 24 hours. Electrophysical examinations (EPU) are due if the cardiac arrhythmia is assumed due to a structural heart disease and if a treatment such as catheter ablation is also being considered. If a disease of the heart muscle or the heart valves is suspected to be the cause of the syncope, this can be determined by an ultrasound examination (echocardiography). If the syncope occurred after physical exertion, an exercise ECG is performed.
  • If the doctor suspects a neurologically related cause such as an epileptic seizure as the reason for the faint, the brain waveform is recorded using an electroencephalogram (EEG), among other things. Possible circulatory disorders in the brain or Parkinson's disease can be detected with the help of imaging diagnostics and laboratory analyzes such as CSF puncture (examination of the cerebral water).
  • A color Doppler examination of the cervical vessels can be carried out in order to be able to determine a disturbed blood supply to the brain. For example, it can be determined whether arteriosclerosis is responsible for the circulatory disorder and syncope.
  • If a psychological cause for the fainting (psychogenic syncope) is assumed, further diagnostics can be carried out by a specialist in psychiatry and psychotherapy. If psychotropic drugs were taken at the time of the syncope, it will be clarified whether these could be partly responsible for the collapse.
  • If syncope occurs due to drugs that lower the heart rate or blood pressure, the doctor will either change the dose of the drug or prescribe a different active ingredient.

Syncope treatment

Which therapy the doctor initiates after a thorough examination of the patient depends on the disease at hand. Many sufferers come to the emergency room after syncope. If this is the case, the cause of the fainting can be determined directly in the hospital. If follow-up treatment is necessary, it will be carried out here immediately. If, for example, cardiac arrhythmias are diagnosed, the activity of the heart should be monitored for some time via a monitor. A patient suffering from subclavian steal syndrome receives therapy that consists of expanding the vessels by inserting a stent or bypass surgery. If the syncope is based on a circulatory disorder and the patient is otherwise healthy, no therapy is required. However, if he suffers from recurrent syncope, medication can also be prescribed.

Homeopathy for syncope

If someone faints, there can be many causes. For example, shock after a blow or fall, lack of fluids, or a serious illness. For some syncope triggers, homeopathic remedies can be used effectively. The respective underlying disease and the individual symptoms must be carefully considered.

The most important homeopathic medicines for Synkope include:

  • Aconite
  • Arnica
  • Camphora
  • Carbo vegetabilis
  • Veratrum album

Acupuncture for syncope

Acupuncture, a therapeutic method of traditional Chinese medicine, is also recognized in Germany for numerous indications for the treatment of diseases. There are 361 acupuncture points on so-called meridians (energy lines) that run through the body. Depending on the diagnosis, certain points are stimulated by needle pricks. Acupuncture is also used for syncope caused by low blood pressure.

Syncope - ICD code

In medicine, every illness is assigned its own ICD code. The abbreviation ICD stands for International Statistical Classification of Diseases and Related Health Problems. The classification system is recognized worldwide and is one of the most important for medical diagnoses. For example, syncope and collapse are recorded under the ICD code "R55". Entering this code often helps with research on the Internet.

Syncope - How Do I Find the Right Hospital?

When looking for a suitable hospital that is well versed in the treatment of syncope, the website www.aerzteblatt.de provides some helpful links. Among other things to www.weisse-liste.de, www.kliniken.de and www.krankenhaus.de. The website www.kliniken.de offers a particularly comprehensive overview. There are currently 3,846 hospitals from Germany, Austria and Switzerland listed here. In addition, there is detailed information on the specialist departments of the clinics as well as quality reports.

Go to the homepage of www.kliniken.de: Under the menu item “Top-10” you can search specifically for diseases and diagnoses. For syncope and collapse, enter the code "R55" in the left column (under "Diseases and diagnoses according to ICD10"). Then the following field appears directly below: "XVIII Symptoms and abnormal clinical and laboratory findings that are not classified elsewhere". If you click on it, another field "R50-R69 general symptoms" opens. If you click on it again, the field “R55 syncope and collapse / fainting or collapse” appears. Click here again and the corresponding hospitals will now appear in the mask on the right, sorted according to the ranking of their case numbers. The Frankfurt Höchst Clinic in Frankfurt am Main is in first place, the Dortmund Mitte Clinic in second place and the Munich Clinic Harlaching in third place, etc.

Syncope - What does the health insurance company pay for and what do you have to pay yourself?

Members of a statutory health insurance basically have the right to inpatient and outpatient care, to drugs and other services. As a rule, however, certain personal contributions (additional payments) are stipulated by law. These additional payments amount to 10 percent of the costs, but a maximum of 10 euros per additional payment. If the service costs less than 5 euros, the insured person must pay the actual price.

These limits also apply to pharmaceuticals. If the person concerned receives a particularly inexpensive preparation, there is no additional payment. The health insurances can determine fixed amounts that they reimburse if several preparations with the same active ingredient are available. Medicines, the price of which is 30 percent below this fixed amount, are reimbursed by health insurance companies without additional payment.

In addition, there is a regulation that the statutory health insurance no longer has to reimburse the individual price of the respective drug for certain preparations, but only the fixed amount that has been set for a group of comparable preparations. If the prescribed medication is more expensive, the patient has to pay the additional price himself plus the statutory additional payment for the reimbursed portion of the costs.

Co-payments also apply in the event of a hospital stay. They amount to 10 euros per calendar day, whereby the additional payment only has to be made for a maximum of 28 days per year. Several hospital stays can be combined in one year, so that the maximum additional payment for inpatient treatment is 280 euros per calendar year.

In the case of home nursing, a one-time fee of ten euros is due for the prescription. In addition, a personal contribution of 10 percent per day is to be borne. The co-payment is limited to 28 calendar days per calendar year and is only charged for adults over 18 years of age. The upper limit of EUR 280 per calendar year also applies to home care. Co-payments for hospital stays count towards the cap on co-payment for home nursing.

If the costs for household help are covered by the health insurance, the insured must make an additional payment of 10 percent of the costs incurred. The limits are at least 5 and a maximum of 10 euros per calendar day. This co-payment obligation applies to the entire period in which domestic help is used.

In the case of aids, the insured must make an additional payment of 10 percent of the selling price, with an upper and lower limit of 10 and 5 euros per prescription.

The amount of co-payments for rehabilitation measures depends on the measure and the respective cost bearer.

The costs for pain therapy in a pain clinic are usually covered by any statutory health insurance company, as it is a contracted medical service. However, additional costs (such as additional payments for prescriptions) may arise privately.

The costs of a classic body acupuncture are covered by all statutory health insurances for chronic pain in the lumbar spine or knee osteoarthritis. It is assumed that the pain has existed for at least six months. In such cases, legally insured persons are entitled to up to ten acupuncture sessions per case of illness within a maximum of six weeks. A new treatment can take place no earlier than twelve months after completion of the last acupuncture treatment. The health insurance will only reimburse the costs if the treatment is carried out by a qualified doctor. Acupuncture from a naturopath is not accepted. The costs are then to be paid privately.

Syncope - What does the DFV do?

The outpatient supplementary health insurance DFV-AmbulantSchutz reimburses you for additional payments provided for by law for medicines, bandages, remedies and aids and travel costs as part of outpatient treatment. The DFV-AmbulantSchutz also offers you extended pension benefits and is also there to support you financially if a serious illness is diagnosed.

In the event of illness, with the additional hospital insurance DFV-KlinikSchutz Exklusiv, you do not wait longer than 5 days for an appointment with a specialist doctor.

You also benefit from head physician treatment, a single room, free choice of hospital and daily hospital allowance for an inpatient clinic stay. DFV-KlinikSchutz makes you a private patient in the hospital including international health insurance.

FAQ about syncope

How is syncope diagnosed?

After a detailed questioning of the doctor's symptoms, existing illnesses and a precise description of the sudden fainting, the patient is subjected to a physical examination. Basic technical diagnostics include blood pressure measurement while lying down and standing, long-term blood pressure measurement, a tilt table examination and a Schellong test. If heart disease is suspected, an EKG and, if necessary, a heart ultrasound are also performed. To clarify neurological causes, the brain waves are often recorded with an EEG. Laboratory analyzes can also be useful. Further examinations may follow depending on the suspected cause of the syncope.

How can you prevent syncope?

Those who are prone to recurrent syncope, which is harmless, may be able to avert fainting more often with the following tips: Avoid standing for long periods of time, as well as long stays in warm and stuffy rooms as well as stress and alcohol. Strong pressure on the toilet should be avoided, as well as strong blowing of the nose with a cold. If you have to lift heavy objects, you should never do it jerkily. To counteract syncope, it makes sense to stabilize the circulation. Endurance sport is a good tool, and adequate hydration is also important. Alternating baths are also effective. Compression stockings should be worn in jobs that require long periods of standing. They help the blood flow back from the legs to the heart.

Why can a sports injury lead to syncope?

Severe pain, for example suddenly bending over while jogging, can cause brief loss of consciousness (vasovagal syncope). The shooting pain causes cold sweat to break out of all pores, the jogger becomes nauseous, he becomes very pale and his senses fade. Everything happens very quickly: there is a drop in pulse and blood pressure, the vessels widen, muscles slacken and a brief faint occurs.

What is convulsive syncope?

A so-called convulsive syncope is a common form of syncope. This leads to motor excretion of individual muscles or to non-synchronized cramp-like movements of the extremities. Regardless of its causes, all syncope can express itself in this way.

How do you know that syncope is imminent?

There is syncope that occurs without warning. This is the case, for example, with cardiac arrhythmias. Sometimes before the attack there are unconsciousness (orthostatic or vasovagal syncope) but also noticeable symptoms such as fatigue, compulsive yawning, nausea, dizziness, sweating, feelings of cold, paleness, tremors and palpitations. In turn, other sufferers suddenly go black or have ringing in their ears. Pain in the chest, neck or back is also possible. However, these symptoms can also be an indication of a life-threatening illness.

All statements without guarantee.

swell

  • Herold, Gerd .: Internal Medicine, Gerd Herold, Edition 2019

  • S1 guideline "Syncope" of the German Society for Neurology (as of September 2012)

  • The technicians: www.tk.de (accessed July 30, 2019)

  • Homeopathy Online (German Central Association of Homeopathic Doctors): www.homoepathie-online.info (accessed August 1, 2019)

  • Association of German Heilpraktiker (BD) e.V .: www.bdh-online.de (accessed August 1, 2019)