November 24, 2020
Syncope refers to a transient loss of consciousness. There are many reasons as to why a syncope may occur. Based on those reasons, various types of syncope can be derived. These can be cardiogenic, neurogenic, psychogenic or a variety of other reasons. The one we would be focusing on in this article is vasovagal syncope. This type of syncope is also called reflex syncope.
The word vasovagal can be split into the words "vaso" and "vagal." Vaso refers to blood vessels whereas Vagal refers to the vagus nerve. The vagus nerve is one of the most important cranial nerves in the body which has multiple functions. These functions are spread across the cardiac, digestive, urinary and endocrine systems. One of the functions of vagus nerve is to regulate the activity of the blood vessels. An individual enters the state of a vasovagal syncope when there is dysfunction in the regulation of the vagus nerve on the blood vessels.
A vasovagal syncope happens due to a certain trigger. This trigger can be pain, emotional stress, phobia, sight of blood, etc. Once the trigger kicks in, there is an initial increase in the heart rate and blood pressure. This is followed by a rapid decrease in both the levels. The abrupt decrease affects the cardiac output. Cardiac output is the total amount of blood pumped by the heart. When this gets affected, there is a decreased distribution of blood across the body. An individual might feel dizzy, can have nausea, feel a change in the body temperature initially. This is followed by slurred speech, ringing in the ears and sweating. The person will then start to lose his consciousness gradually as the vision slowly becomes hazy.
The loss of consciousness results in the person falling down. If he or she is not protected during the fall, chances are that a simultaneous traumatic injury can occur as well. Once the person is in syncope it is important that his/her legs are lifted above the trunk. The main goal is to let the blood flow in the direction of the brain. This can help in immediate restoration of the brain's function and can help the person regain consciousness. If the head is kept above the level of the trunk or the legs are not lifted, it is difficult for the blood to reach the brain. This can lead to an abnormal functioning of the brain cells which an trigger epileptic attacks and seizures. A person in vasovagal syncope should be made to lie down for a few minutes. Sitting or standing up immediately after regaining consciousness may lead them to a state of fainting.
In a dental operatory, the sight of needles or the process of a tooth extraction can often lead the patients to a vasovagal syncope. The first step for a dentist is to lead the patient into a supine (lying down on the back) position on the dental chair. Next, the patient is given some electrolytes and fluids which is crucial to the patient regaining his or her energy.
Treatment of a vasovagal syncope includes psychotherapy of the patient against the triggering agent. For example, patients can be educated about the triggering agent like blood, needles, etc as to how and why are they harmless. Moreover, patients can also be asked to fold their legs or clench their fists during the procedure which can help in increasing blood flow to the brain. A patient who is at a risk of vasovagal syncope should never be asked to calm down completely as vasovagal syncope already causes a drop in blood pressure. Medications like beta-blockers, which can help regulate the rhythm of the blood flow can be given to the patients. In some severe cases, brain stimulants can also be prescribed. The medications for vasovagal syncope only temporarily help in the stabilization of blood vessels and heart rhythm. These do not ensure that a patient will never have a vasovagal syncope in the future.
It is important to note that vasovagal syncope is not a life threatening condition. It is only a transient loss of consciousness that can be regained with some simple measures. The most crucial thing during a vasovagal syncope is to ensure that during the fall caused by the loss of consciousness, a person does not fall down fatally.