Welcome, my name's Dr. Warrick Bishop. I'm a cardiologist, I'm an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Hi, my name's Dr. Warrick Bishop and welcome to my podcast and videocast station. Thank you so much for tuning in. Today I'd like to share a little bit with you... from the Cardiac Society Australia New Zealand meeting that was the scientific meeting held in Adelaide this year. It was a terrific opportunity to learn and not only new stuff, but recap on old stuff. Beyond that, it's also a great chance to network and catch up with friends and discuss cases. really chew the fat around cardiology for about three or four days. Well, I'm going to share with you a few pieces from a session I went to, and these sessions run for about an hour and a half or thereabouts, two hours. This session is on, the title of this session is Syncope. Now you may have heard of the word syncope. In medicine, we use it to mean blackout. Well, syncope may be familiar to those of you who play instruments or music and understand that the term syncopation is also used for music that has pauses in it. So syncope, meaning a pause, it's the word we use for blackout. I went to a fantastic session on this. The first presenter was a Neil Strathmore, Kiwi colleague, who talked about syncope and how we break it down and think of it and the importance of history. So when we think of loss of consciousness, we obviously think of non-traumatic episodes and think of traumatic episodes. In this particular presentation and for today's podcast, traumatic episodes really aren't required to be discussed. Let's talk about the non-traumatic loss of consciousness, the ones that occur out of the blue. So there is syncope, which is probably heart-related, generally some sort of problem with the heart rhythm, perhaps even a valve. Sometimes we see blood pressure drop profoundly as well. We also can think of non-traumatic loss of consciousness as an epileptic seizure. And there can also be rare causes such as a bleed in the brain. Very, very occasionally there can be psychogenic causes. These are psychiatric, if you like, non-epileptic. type seizures. The main sort of issues that Neil Strathmore went through were the sort of cardiac based ones versus epilepsy, because these are probably the two main ones that we think about. When we think about cardiac syncope, if there's presence of structural heart disease or a family history of sudden cardiac death, we'd certainly be thinking primary heart related or heart structural related issues. Importantly, cardiac syncope may occur during exertion because, for example, there might be a narrowing of a valve. But it can also occur when people are at rest, which would point to an arrhythmogenic sort of problem. Generally a sudden onset. Rarely are there any palpitations or indications it's going to happen. Orthostatic hypotension talks about the sort of syncope that people get. when they stand up and go from sitting to standing or lying to standing. And often can be the case that this is related to breakdown of the autonomic nervous system, which we might see in things like Parkinsonism. It may occur more likely if these individuals have been made to stand for a period of time or have eaten food prior or exercised prior, as there can be dilatation of the... blood vessels within the legs or the gut, depending on what the person's done. The syncope that many of us, or the blackout that many of us would be at least familiar with to some degree, perhaps we've even seen it on TV, is where someone passes out at the sight of blood. That's sort of what we would call a vasovagal syncope or a reflex. neurocardiogenic syncope now a vasovagal syncope is all about the autonomic nervous system the slowing down nervous system the rest and digest nervous system being over triggered and emotional episodes can cause that unpleasant sight sounds smells prolonged standing being hot being in a crowded room often these people It's a different sort of syncope. Often these people will have some pre-warning. So they might feel hot, want cold air, may want to get up and move outside, may feel nausea as well because of that rest and digest process. So very important we think about cardiac syncope, structural heart problems, familial problems, orthostatic hypotension, generally some sort of positional component telling us about it. And vasovagal syncope, also called reflex syncope, this being linked to something that will often explain it away and often have that prodrome symptomatology. So it gives us a clue. This is in contrast to epilepsy that may have some sort of aura that may well give people a sign. interestingly can be associated also with those jerking movements that we see with or we think of when we think of an epileptic seizure. Those jerking movements or myoclonus start at the onset of the loss of consciousness as opposed to those jerking movements that may occur after the Loss of consciousness has been present for some time. It's a different process. That's just lack of oxygen to the brain triggering something that looks like that. Similarly, tongue biting, which is lateral, so the sides of the tongue being affected, are more likely to be related to epilepsy as opposed to biting the tip of the tongue, which might be from a cardiac syncopal episode and the patient simply falling over face first. or chin first, and their chin being smashed up to their maxilla and the tongue being caught in between. Incontinence and fatigue are certainly possible with epilepsy as well. Neil Strathmore's point was that because of the variances in these types of presentations, And each of those variances link back to a different cause or etiology of epilepsy that the history surrounding exactly what happened is extremely important. And often it's the case that the patient may not know exactly what's gone on because of a component of amnesia or because it was extremely sudden. So sometimes that history needs to be drawn if possible. from people who are nearby or family and relatives who either found the patient or were with the patient when the episode occurred. So, syncope or loss of consciousness, non-traumatic, can be heart-related, epileptic, and then some rare causes like subarachnoid hemorrhage or psychogenic. If we think about the... cardiac versus epileptic causes then we're thinking of that typical vasovagal type syncope we're thinking about orthostatic hypotension so standing up blood or running to the boots and away from the brain these people falling over because of really lack of perfusion to the brain structural cardiac syncope where there may be a structural abnormality with the heart for example a tight aortic valve or a predisposition that could be inherited such as a long QT syndrome giving rise to funny rhythms or hypertrophic cardiomyopathy giving rise to funny rhythms as well and this is in contrast to epilepsy which there may be a past history there may have been a trigger for the particular episode on occasions there'll be some sort of aura with it the jerking will start at the onset of the Loss of consciousness, lateral tongue biting rather than tip of tongue biting is noted. And there can be post seizure confusion, maybe continence and fatigue. Well, I hope I haven't given you syncope talking about syncope. I'm going to wrap it up there. I hope you found this an interesting little walk through the things that cause blackouts. If you have any queries or questions, please drop us a note. Always love to hear. If you've got any ideas for future podcasts or so, let us know. For now, however, I'm going to wish you the very best. I hope you live as well as possible for as long as possible. Take care and bye for now. Did you know that coronary artery disease kills one in four people? So most of us... are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk check out www.virtualheartcheck.com.au It will give you information about risk and what else can be done to be even more precise.
