Discomfort and loss of consciousness .
CLINICAL CASE: A 42-year-old woman; with insulin-dependent diabetes for four years; her usual treatment consisted of 20 U of delayed-release insulin morning and evening.
His medical history includes pneumonia treated a year ago.
During dental care: the patient presents with discomfort such as dizziness; sweating; blurred vision; dyspnea; low blood pressure; bradycardia
A return to normal is observed after two minutes, but chest pain and great weakness persist.
- What are your diagnostic hypotheses?
- What is your initial support?
Discomfort: Syncope. Lipothymia.
1. Key points
- Loss of consciousness is a cessation of brain function of variable duration and onset.
- Syncope: a brief, sudden, complete loss of consciousness; a reduction in cerebral blood flow; a state of apparent death: no pulse; heart sounds; apnea; pallor. Spontaneously resolves, reversible. A few seconds to 1 or 2 minutes. A fall: trauma
- Lipothymia: a feeling of fainting without loss of consciousness: feeling of fainting; feeling of emptiness; loss of balance; hot flashes; visual disturbances; respiratory depression; great weakness; sudden anxiety.
-Causes: emotional shock; fear; pain; confined atmospheres.
– minor accident.
-lipothymia can remain isolated or precede a loss of consciousness.
– lipothymia generally refers to presyncopal symptoms associating a feeling of generalized malaise; dizziness; blurred vision, etc.
- Syncope and lipothymia have the same etiologies; but the cardiac origin of lipothymia remains exceptional.
- A common reason for consultation: almost 10% of patients.
- Questioning the patient and any witnesses; careful clinical examination and performing an electrocardiogram will allow an immediate diagnosis to be established or further investigations to be planned.
- The persistence of symptoms following the event: (dyspnea; chest or abdominal pain; neurological disorders; infectious state; etc.) falls outside this framework and should lead to an etiological investigation.
2. Etiological diagnoses:
A. Syncope of cardiac origin: – so-called syncope (Adams Stokes): a patient in a state of apparent death: paroxysmal atrioventricular block.
-syncope on exertion: cardiomyopathy.
– heart rhythm disorders.
B. Syncope of vascular origin:
Vasovagal: Loss of consciousness of vasovagal origin is the most common cause.
– Favoring circumstances.
-loss of consciousness (a few minutes).
-recovery phase.
– these vagal discomforts are usually benign; but sometimes annoying due to their frequency.
C. orthostatic hypotension: positional discomfort; autonomic nervous system dysfunction.
D. syncope of anoxic origin: pulmonary embolism.
E. other origins: -metabolic: hypoglycemia ↔ discomfort in any treated diabetic.
-toxic:
-psychosomatic: young subject; apparent loss of consciousness.
3. In practice
Three main scenarios are presented:
- A completely classic vagal syncope. No additional examination is recommended: preventive measures; information.
- There is no evidence of vagal syncope: cardiac evaluation.
- Patient: cardiovascular risk factors: cardiac assessment : hospitalization: sudden death
Discomfort and loss of consciousness .
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