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SYNCOPE
By Dr. Neromini Fagu
The most common and least life-threatening emergency that may occur in the dental office is a condition called syncope. Syncope, commonly known as fainting, refers to a sudden loss of consciousness due to a decrease in blood flow to the brain. It is usually followed by a rapid and complete recovery. If you have symptoms of dizziness or lightheadedness, without loss of consciousness, this is called pre-syncope.
Syncope is usually associated with a stressful situation in a dental office such as in the administration of a needle for local anesthetic. It affects individuals of all ages, but children, pregnant women, and the elderly are particularly susceptible. When a patient experiences stress, the body reacts by pumping large amounts of blood to the arms and legs to activate the “fight or flight” response. Because the patient is usually motionless in chair, their blood pools in the arms and legs and blood flow to the brain is decreased. This results in oxygen deprivation to the brain.
There are various forms of syncope which are generally classified into one of three distinct categories: cardiac syncope, non-cardiac syncope and neurocardiac syncope. Non-cardiac syncope is sometimes subdivided into orthostatic hypotension and neurologic syncope. Neurocardiac syncope is the most common form of syncope and the type most likely to occur in a dental setting.
Common causes of syncope include:
• Low blood pressure or dilated blood vessels
• Irregular heart beat
• Abrupt changes in posture, such as standing up too quickly, which can cause blood to pool in the feet or legs
• Standing for long periods of time
• Extreme pain or fear
• Extreme stress
• Pregnancy
Episodes of syncope are often preceded by warning signs or symptoms. These may include:
• Nausea
• Slurred speech
• Changes in body temperature that make you feel suddenly flushed or chilled
• Disturbances to your vision, like seeing spots, tunnel vision, blurry vision, or dilated pupils
• Lightheadedness, wooziness, or feeling as if your head and body are weightless
• Dizziness
• Rapid heartbeat
Syncope should not be confused with sudden cardiac arrest. A person with sudden cardiac arrest also loses consciousness suddenly but will die without immediate medical attention. A person with syncope recovers quickly, almost always without treatment. However, up to 35 percent of people who have syncope injure themselves and elderly people are more likely to be injured during a syncopal attack.
Diagnosing Syncope
There are three main ways to identify the causes of syncope: the medical history, the physical examination, and cardiac testing. A medical history and physical examination are recommended for anyone who has had syncope. Some people will also require cardiac testing.
During the taking of a medical history, information about the events that occurred before, during, and after a syncopal episode can be helpful in determining the possible cause of the episode.
Information about current medications and pre-existing medical conditions such as diabetes, heart disease, or psychiatric illness are also helpful for diagnosis.
The physical examination consists of measuring your heart rate and blood pressure to help determine if a rhythm disturbance or low blood pressure caused the syncope. You may be asked to sit or stand while the blood pressure is measured to test for orthostatic hypotension. Your doctor will listen to your heart for abnormal sounds that can be present in conditions such as aortic stenosis.
A number of medical tests may also be used to help determine the cause of the syncope. These include Electrocardiograms and Heart Rhythm Monitoring.
Treatments for Syncope
Treatment of syncope is based upon the underlying cause. The goal of treatment is to prevent recurrences or more serious problems. Medications may also be used for people with a heart rhythm problem to control the rhythm. Neurocardiac syncope treatment can usually be treated by learning to take precautions to avoid potential triggers and minimize the potential risk of harm. This includes keeping dental instruments, needles, and any blood out of the patient’s sight.
When syncope occurs in the dental office, the patient would be laid down in the Trendelenburg position which is lying on their back with the feet slightly elevated above the heart. This position allows the blood to flow back to the head.
For more information contact OMNI DENTAL at 295 Quamina Street, Georgetown Tel: 227-0025, Parika Tel: 260-3133 or send emails to nerominifagu@hotmail.com
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