They are all poor vascular tension, and their psychological and physical qualities will not be too good. They need to adjust their mentality and exercise.
Vasovagal syncope
Syncope refers to sudden and short-term loss of consciousness, accompanied by decreased or disappeared muscle tone, which lasts for several seconds to several minutes and recovers on its own. Its essence is a temporary decrease in cerebral blood flow. Cardiovascular diseases, nervous system diseases and metabolic diseases can all cause syncope, but there are still many patients who can't find the cause according to clinical history, physical examination and auxiliary examination, which has long been called "unexplained syncope".
Vasovagal syncope refers to the reflex mediated by vagus nerve to various stimuli, which leads to the dilation and bradycardia of small blood vessels in viscera and muscles, the sudden dilation of peripheral blood vessels, and the decrease of venous blood returning to the heart, which makes the heart have the reflex function of accelerating and strengthening contraction. Some people will suddenly slow down their heartbeat due to excessive stimulation of vagus nerve and parasympathetic nerve, and the peripheral blood vessels will dilate, resulting in a drop in blood pressure and hypoxia in the brain, which is manifested as arterial hypotension, accompanied by short-term loss of consciousness and self-recovery, and no signs of neurolocalization. Vasovagal syncope is very common, and it often recurs, especially when the mood is under considerable pressure, extreme fatigue, pain and panic, or in a crowded and sultry room. In recent years, some scholars think that it may be more appropriate to use "neurocardiogenic syncope" because the blood vessels in other parts of the body are not dominated by vagus nerve except the heart. The main clinical manifestation is recurrent syncope.
First, the pathogenesis
Although Lewis proposed the diagnosis of vasovagal syncope for nearly 70 years, its etiology and pathogenesis have not been fully clarified so far. At present, most scholars believe that its basic pathophysiological mechanism is that the compensatory reflex of autonomic nervous system is inhibited, which can not maintain the compensatory response of cardiovascular system to long-term upright posture. When a normal person stands upright, due to the action of gravity, blood gathers in the lower limbs, the blood in the head and chest decreases, and the venous return decreases, which makes the ventricles full, and the baroreceptors located in the ventricles lose their load, reducing the impulse to the brain stem center, reflexively causing the sympathetic nerve excitability to increase and the parasympathetic nerve activity to weaken. Usually manifested as an increase in heart rate, a slight decrease in systolic blood pressure and an increase in diastolic blood pressure. However, patients with vasovagal syncope cannot maintain the compensatory cardiovascular response to long-term upright posture. It has been reported that in patients with vasovagal syncope, the level of catecholamine in circulating blood and the adrenergic nerve tension of the heart continue to increase, which leads to the high contraction state of ventricular relative emptying, and then overstimulate the mechanical receptors (unmyelinated C nerve fibers) in the lower posterior wall of the left ventricle, which suddenly increases the vagal impulse to the brain stem, induces reflex tachycardia contrary to normal people and relaxes peripheral vasodilation, leading to severe hypotension and bradycardia, causing cerebral hypoperfusion, cerebral hypoxia and syncope.
In addition, neuroendocrine regulation has been found to be involved in the pathogenesis of vasovagal syncope, including renin-angiotensin-aldosterone system, catecholamine, serotonin, endorphins and nitric oxide, but the exact mechanism is still unclear.
Second, the clinical manifestations
Usually manifested as sudden syncope when standing or standing up. Before the onset, there may be short-term symptoms such as dizziness, inattention, pallor, decreased vision and hearing, nausea, vomiting, sweating and unstable standing. In severe cases, it may take 10-20 seconds. If you can be alert to this omen and lie down in time, you can alleviate or disappear. At first, my heart often beats faster and my blood pressure can be maintained. Later, the heart rate slowed down and blood pressure gradually dropped. Systolic blood pressure is significantly lower than diastolic blood pressure, so the pulse pressure difference decreases. When the systolic blood pressure drops to 10.7Kpa(80mmHg), there may be a loss of consciousness for several seconds or minutes. A few patients may wake up with incontinence, fatigue, dizziness and other discomfort. In severe cases, symptoms such as forgetfulness, trance and headache after waking up may occur. Physical examination during the attack showed signs such as decreased blood pressure, slow heartbeat and dilated pupils. There are usually no positive signs between seizures. It has been found that vasovagal syncope can induce convulsive syncope, which is easily misdiagnosed as epilepsy. It can induce high temperature, poor ventilation, fatigue and various chronic diseases.
Fourth, diagnosis and differential diagnosis
For repeated syncope attacks, it is not difficult to make a definite diagnosis by inquiring about the medical history in detail to understand the symptoms and signs during the attack, and then with the help of ECG, EEG, biochemical examination, upright tilt table test and other necessary auxiliary examinations, but it should be differentiated from the following diseases:
1. Cardiogenic syncope: This disease is caused by sudden decrease or suspension of cardiac output caused by heart disease, leading to cerebral ischemia. It is more common in severe aortic or pulmonary valve stenosis, atrial myxoma, acute myocardial infarction, severe arrhythmia, Q-T interval extension syndrome and other diseases. It is easy to distinguish between medical history, physical examination and ECG changes.
2. Hypoglycemia: This disease often has a history of hunger or use of hypoglycemic drugs, mainly manifested as fatigue, sweating, hunger, and then syncope and unconsciousness. The onset of syncope is slow, and there is no change in blood pressure and heart rate during the attack. Unconscious disorder can be detected, blood sugar is decreased, and intravenous injection of glucose can quickly relieve symptoms.
3. Epilepsy: Children with vasovagal syncope presenting as convulsive syncope should be differentiated from epilepsy, and EEG and head-up tilt test are not difficult to distinguish.
4. Erection adjustment disorder: The symptoms of the disease are dizziness, dizziness, chest tightness and discomfort when standing upright from prone position or standing upright for a long time. In severe cases, it can cause nausea, vomiting and even fainting. Without treatment, it can quickly wake up and return to normal. It can be identified by upright test, upright tilt test, etc.
5. Hysterical syncope: There are obvious mental factors before the onset, but before the crowd. During the attack, he was conscious, held his breath or hyperventilated, struggled with his limbs, closed his eyes and blushed. Pulse and blood pressure are normal, and there are no pathological neurological signs. The attack lasts for several minutes to several hours. After the attack, the mood is unstable. Walk slowly if you feel dizzy, and you won't get hurt. You often have similar seizure history, and it is easy to distinguish vasovagal syncope.
In addition, this disease should be differentiated from hyperventilation syndrome.
Verb (abbreviation of verb) processing
At present, there is still a lack of specific treatment methods and drugs for vasovagal syncope. For some high-risk groups who have no premonitory symptoms and often fall suddenly, especially those who have repeated injuries or are often exposed to fragile environments, preventive treatment is needed. The goal of treatment is to reduce the incidence of severe syncope and reduce trauma. There are many methods to treat vasovagal syncope, which vary from person to person.
(A) Education and improvement of lifestyle
Vasovagal syncope is often triggered by some factors, some of which may only occur under certain circumstances. Therefore, it is necessary to do a good job in the education of patients and their families, try to avoid these incentives, and try to stop using drugs that can cause postural hypotension. Once the aura of syncope appears, the patient should lie flat immediately to avoid trauma and syncope. It has been reported that in patients with recurrent vasovagal syncope, flexing limbs during prodromal symptoms is helpful to prevent syncope, which may be related to the increase of venous blood reflux by pumping blood from skeletal muscle. Increasing the intake of fluids and sodium salts may also help prevent syncope. Younoszai and El-Sayed found that patients with vasovagal syncope can take at least 2L solution and 120mmol sodium (about 7g salt) every day, which can increase blood pressure, increase blood volume and reduce syncope frequency. Some clinicians also suggest standing training, similar to "desensitization" therapy. Let the patient stand against the wall every day 10 ~ 30 min, and gradually adapt to the influence of this posture ability change.
Abstract of intransitive verbs
For patients with syncope, three aspects of information should be obtained first-medical history, physical examination and routine 12 lead electrocardiogram. Detailed medical history and physical examination provide a direction for the diagnosis of syncope. Electrocardiogram helps to rule out many cardiogenic diseases, and then carry out targeted examinations to determine the cause of syncope as much as possible. Typical medical history and physical examination can make the diagnosis of vasovagal syncope. However, for high-risk patients who have no prodromal symptoms and are vulnerable to trauma, it is best to do echocardiography and head-up tilt test for further evaluation.
The treatment of vasovagal syncope is mainly publicity and education. Encourage patients to increase their intake of water and sodium and try to avoid triggers. When the symptoms of frontal drive appear, they should lie flat immediately and bend their arms and legs to avoid trauma. If the patient wants, he can try standing training, standing against the wall for 5 minutes every day, and gradually increase it to 15 ~ 30 minutes. High-risk patients who are easily injured without prodromal symptoms should take preventive drugs. It is recommended to take metoclopramide, 5mg a day, three times a day, and if it still appears, it can be increased to one day 10mg. If the symptoms are relieved but still can't be completely controlled, hydrocortisone, 0. 1mg daily, or selective serotonin reuptake inhibitors can be added. If the patient 1 year is asymptomatic, the dosage can be gradually reduced until the drug is stopped, but if the symptoms recur, it is necessary to start taking the medicine again.
Generally speaking, patients with vasovagal syncope have a good prognosis, but for the elderly, due to the high risk of syncope, more attention should be paid.
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