Blackout (Syncope)- Loss of consciousness
Syncope is a medical term used to describe sudden brief loss of consciousness. There are various reasons why people can have syncope, but the two common reasons are due to brain and heart disorder. A proper description of the event with timings by eyewitness or family members can give a clue to differentiate between heart and brain disorders. The common heart problem that can cause syncope is either due to electrical problem in the heart or due to reduced pumping of the blood by heart. Either a very slow heart rate or a very fast heart rate can cause syncope. Sometimes patient describes typical symptom of dizziness/giddiness prior to syncope. In patients who have symptoms of chest pain and sweating prior to collapse, this is a classical sign of heart attack and they have to be rushed to a hospital with appropriate facilities to treat the heart attack and revive them. Occasionally, patient or family members will describe a typical drop-attack in which patient was normal until the collapse without any preceding symptoms.
In some instances people who have syncope will start to have jerky movements of arms and legs after the event. This is commonly mis-diagnosed as having fits and started on medications for fits, but actually the patient may have a heart problem.
In patients who had syncope, they have to be assessed both by cardiologist and Neurologist. Few tests need to be taken relevant to the history given by the patient. An ECG and an echocardiogram give basic insight into the condition of the heart. They may also need to have a 24 hr ECG monitoring (Holter) to see if they develop slow or fast heart beat at any time during the monitoring period. In patients who describe chest pain with syncope, they should also have coronary angiogram to look for blockages in the blood vessel. Neurologist may recommend a CT scan of the brain and EEG depending on the history.
Patients who have a slow heart rate and syncope may need a pacemaker to prevent further episodes of syncope. Pacemaker insertion is a simple procedure, which involves positioning one or two wires in the heart that is connected to a battery, and the battery will be placed under the skin below the collar bone. This will take care of the electrical conduction problem in the heart. In those patients, who have very fast heart beat, there are options to do ablation procedure to stop the unwanted fast heart rhythm. In certain dangerous fast heart rhythm, an internal defibrillator (ICD) needs to be implanted to prevent further collapse.