What is “Syncope” & “Orthostatic Hypotension”?

What is “Syncope”?

“Syncope” means loss of consciousness due to decreased blood supply to the brain. “Syncope” is the most important and common Seizure Mimic.

Some events look almost precisely like seizures but are not seizures. These events are called “Seizure Mimics”, and may be mistaken for seizures.

There is NO electrical surge in the brain with any of these “Seizure Mimics”.

If an episode of  Syncope is mistaken for a Seizure, two things happen: Unnecessary treatment with anti-epileptics, and lack of treatment for the “true” condition (e.g. cardiac arrhythmia).

Which problems cause “Syncope”?

Lets quickly summarize how blood goes to the brain: The heart receives oxygenated blood from the lungs. It pumps this blood to the brain through large blood vessels in the neck.

MJgixoSIbW
The heart takes oxygenated blood from the lungs and pumps it to the brain.

4 Groups of problems can cause Syncope:

4 Problems causing Syncope
– Heart problems
– Overactivity of the vagal nerve
– A sudden drop in BP on standing up (Orthostatic Hypotension)
– Problems with blood vessels going to the brain

Which heart problems can cause Syncope?

  • If the heart has become weak (for example due to multiple heart attacks) and not able to pump enough blood, the patient may occasionally lose consciousness. This cause is not very common.
    2LeuF3p9u8
    A weak heart can cause episodes of unconciousness (syncope)
  • More common is an obstruction to blood flow in the heart.
    Valves in the heart usually keep blood moving in only one direction. They can open and close as needed. Sometimes the heart valves (especially a valve called the Aortic Valve) may become damaged and incapable of opening completely – this decreases blood flow to the brain. Sometimes, the heart wall around the Aortic Valve may become thickened producing the same effect – this condition is called “Hypertrophic Sub-Aortic Stenosis”.
    An echocardiogram quickly & easily detects these structural problems.

    RtIVhOgtJP
    Valve problems in the heart may obstruct the flow of blood and cause episodes of unconciousness (syncope)
  • A straightforward problem to miss is Cardiac Arrhythmia. Usually, the heart beats regularly, almost like a clock. But if the wiring system of the heart develops problems, it may have episodes where it suddenly stops beating or starts beating very rapidly without pumping any blood. This condition is called a cardiac Arrhythmia (A = lack of – rhythm).
    Since these rhythm problems occur only once in a while, a single ECG may miss them. Therefore, an EEG machine that is stuck to your chest and records your heart rhythm for many days (A Holter Monitor) may be required. Newer devices called External Loop Recorders (ELDs) can record your heart rhythms for many months at one time!
    You may require a pacemaker if you have a severe cardiac arrhythmia.

    VnoorSQq7K
    An irregularly beating heart can cause unconciousness (syncope)

What do you mean by overactivity of the Vagal Nerve?

The vagal nerve is a long nerve from the brain to the heart. When it is active, it can decrease the heart rate.

Q1sPpoNuP6
The vagus nerve is an extremely long nerve that goes to many organs, including the heart.

If something overstimulates the vagal nerve, it can become overactive. It then causes the heart to become very, very slow. This causes decreased blood flow to the brain and leads to loss of consciousness.

It is easy to identify the precipitant that caused the vagus nerve overactivity. The following is a list of such precipitants. Only the first one is common:

  • Intense Emotion or Pain: Being startled, the sight of blood, intense fear etc
  • Choking on something. Rarely swallowing very cold or hot food can cause Syncope.
  • Massaging the neck or wearing a very tight collar (which leads to stimulation of sensors called carotid bodies which are connected to the vagus nerve)
  • Passing urine (Micturition Syncope)
  • Rarely: Laughing hard and Orgasms

What can cause a sudden drop in Blood Pressure on standing (Orthostatic Hypotension)?

Meaning of Orthostatic Hypotension
Ortho = Straight,  Statikos = to stand
Hypo = Low, Tension = Pressure

Meaning: Low Pressure on Standing Straight

pGJYl56Zzv
A drop in blood pressure may cause unconciousness (syncope)

When we stand up suddenly, blood tends to pool in our legs, and our brain tends to get less blood. To prevent this, the blood vessels in our legs contract and our heart beats faster. If these things don’t happen, our heart pumps less blood, and our blood pressure drops. This may cause us to lose consciousness.

NfMHdzaO1E
When some people stand up suddenly, their brain does not get enough blood. This is alled Postural or orthostatic hypotension.

A sudden and large drop in our Blood Pressure on getting up suddenly is called “Orthostatic Hypotension”.

During your office visit, the doctor may check your BP when you are lying down and then ask you to get up suddenly. While you are standing, he/she will check your BP two more times. If your upper (systolic) BP drops by more than 20 units, or your lower (diastolic) BP drops by more than 10 units, its likely that your events are due to Orthostatic Hypotension.

In some cases, an advanced test called a “Tilt Table Test” confirm the diagnosis.

oWgA2H9Rc3
A tilt table test is used to diagnose postural hypotension.

What can cause this drop in BP? There are many causes! It is difficult to remember all of these causes, but I list them here so that you can understand the monumental task facing your doctor and are patient while he goes through a series of tests to find the exact cause of your orthostatic hypotension:

Causes of Orthostatic Hypotension

Examples

Brain Problems– Parkinson’s disease and its sisters like MSA

– As part of normal ageing

Nerve problems (Neuropathy)Damage to nerves controlling the heart & blood vessels due to:

– Alcoholism

– Diabetes

– B12 deficiency

– HIV

– Many others…

Heart Problems– Cardiac failure

– Valve problems

Dehydration

 

Not enough fluid in the body due to:

– Drinking very little water

– Diarrhoea or vomiting

Hormonal Problems– Low functioning of the Adrenals (Addison’s)

– Low thyroid levels

– Pheochromocytoma

MedicationsMany, many medications including:

– Blood pressure medications

– Antidepressants

– Anti-parkinson’s medications

Click here for a: [longer list]

The best treatment of Orthostatic Syncope is the treatment of the underlying problem, e.g. replacing the problematic medication. In some cases, medications such a Fludrocortisone, Midodrine or Pyridostigmine may be useful.

 

What problems with blood vessels can cause Syncope?

Usually problems with blood vessels going to the brain present with a stroke, with weakness on one side of the body. Blood vessel problems presenting only with episodes of unconsciousness and being confused with seizures are rare. Therefore, these are only briefly described below:

  1. If the blood vessels going to the brain – especially the carotid arteries described above – become narrow (e.g. due to accumulation of cholesterol) then the person may have episodes of sudden unconsciousness.
    t4IIPGBbI5
    Rarely, if an artery going to the brain is narrow or is misconnected to the arm vessels, you may have repeated episodes of unconciousness (syncope).
  2. Occasionally when blood that is going to head is shunted away to the arm, the person may get episodes of unconsciousness whenever he/she uses that arm. This condition is called Subclavian Steal syndrome.

 

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

Send Message


NeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar IconNeuroPlus Epilepsy & Parkinson's Clinic - Dr. Kharkar

near LIC, Dr Balabhai Nanavati hospital, near LIC, SV Road, LIC Colony, Vile Parle

4.5 77 reviews

  • Avatar Paras Prabhu ★★★★★ a month ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Sanjay Pradhan ★★★★★ 2 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar Pinakin Shah ★★★★★ in the last week
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Manish Ranjan ★★★★★ 3 months ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar aman ul hauq Khan ★★★★ 2 months ago
    Dr Kharkar gives you all the time you need to hear you out in complete detail. He probes in depth to ensure he has managed to gain all data points to find … More the best way forward medically for you. He is an authority on the subject. After 4 years of suffering I have found my go to doctor
  • Avatar N N ★★★★★ 2 months ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Lawrence Castellino ★★★★★ 2 months ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ 4 months ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you
  • Avatar Anil Chinchulkar ★★★★★ 4 months ago
    We have visited the hospital and meet the Dr. S. Kharkar. And my personal experience is very much better and exilent. My father is very well recover as … More we thought. Thanks to Nanavati Hospital and Dr. S. Kharkar.
  • Avatar MAMTA YADAV ★★★★★ 4 months ago
    The services that I received from doctor Siddharth kharkar is excellent ,and the other doctor is also very good who had taken initial discussion with me … More ...and the staff are friendly and ensure that I am properly informed about my health and care and would highly recommend to anyone..
  • Avatar Khushi Valia ★★★★★ 4 months ago
    Had very Severe migraine attacks for years and suddenly my migraine had triggered for continuous 5 days thats when I contact Dr Siddharth and was fortunate … More to have a effective medication which help me reduced my triggers and headaches..Lucky in few months I have very less days of headache in a month and can do my Daily life with much ease.
  • Avatar JAIKUMAR MANI ★★★★★ 9 months ago
    My experience with Dr Siddharth Kharkar was really awesome. It’s always great to be in the presence of someone who is a renowned expert in his field & … More it brings peace of mind that the advice will obviously be the correct one. In addition, his ability to convey complex workings of the human brain in such simple terms that a layman like me could easily understand was something I really appreciated. I heartily Thank Dr Kharkar for his astute advice & gladly recommend him to anyone who needs a neurologist.
  • Avatar Rohit shetye ★★★★★ 10 months ago
    Best Dr. we have ever meet. Dr. Listened to us patiently and gave us the proper solution. No unnecessary test or didn’t frighten us. Thank you so much … More Dr.
  • Avatar Ashish Patil ★★★★★ 10 months ago
    Great doctor!! Really appreciate.The doctor diagnosed me correctly and start treatment that will help me a lots to improve my condition. The doctor is … More really good, calm and his nature is down to earth, gives confidence to patient!!! Thank you!!!
  • Avatar Bianca D'silva ★★★★★ 9 months ago
    We had been looking for a specialist in parkinsons for a while now, for my father and when we found Dr. Siddharth Kharka's details on Google, we were … More partly relieved. Partly because, we were all very anxious not knowing how would our visit turn out. I appreciate Dr. Kharkar and his team. He was very clear in his explanations, his knowledge about parkinsons. He took the time to answer the questions we had, went over the diagnosis and started necessary treatment immediately. The only drawback we experienced was the waiting time. Overall, we left the clinic satisfied, knowing much more than when we walked in. We would highly recommend him to anyone looking for a specialist.
  • Avatar Neelam Satghare ★★★★★ 10 months ago
    I have visited the doctor clinic for the first timeBut he gave good advice and helped me overcomeMy doubts and queries. It was a good experience.I am very … More thankful for cooperation.
  • Avatar Nitin Ghotge ★★★★★ 10 months ago
    Dr.Sidharth Kharkar is one of the best neurologist i came across ....He is really genuine and focused .....We really satisfied after consultancy...
  • Avatar Krishna kumari Radhakrishnan ★★★★★ 11 months ago
    Hi Sharing my experience with Dr KharkarI had consulted with dr regarding my husband’sProblems of tremors. Dr immediately diagnosed on video consultation … More and could help him to control the tremors s of Parkinson’s disease.I found him genuinely polite and free to talk n patiently listening to the patients problem.Now my husband regained his balance n tremors controlled. Many many thanks to Dr Kharkar
  • Avatar a kumar ★★★★★ 10 months ago
    Dr kharkar is very nice doctor, sir explained each and every thing very nicely, and i am thankful for Dr kharkar for his treatment .
  • Avatar Nidhi Sonawane ★★★★★ a year ago
    I had a positive experience with the doctor. He was very sympathetic. His communication skills were good and listened with patience.
  • Avatar Ujwala Sawant ★★★★★ 10 months ago
    Because of Dr.kharkar sir my husband got new life. Tnx sir.
  • Avatar Mythili Balasubramanian ★★★★★ a year ago
    Consultation with the doctor was a very satisfying experience. Was empathetic in his approach, and responded positively to all the queries we had. Thank … More you doctor!
  • Avatar Govind Patel ★★★★★ 11 months ago
    Doctor explained very Good nice person give length time to check body
  • Avatar Sharmila Kumawat ★★★★★ a year ago
    Dr Siddharth is one of the best Dr I have ever met. He is kind, polite, helpful and very selfless person. I have migraine and I am his patient since more … More than 2 years. The staff is always helpful and Dr Siddharth is just beyond words for me. Thank you for ur selfless service and kindness u give to all ur patients.

Leave a Comment

India Today Magazine - 2021Noted as one of the Best Neurologists in Mumbai