Syncope in Korea

Overview

Syncope, commonly known as fainting or passing out, is a sudden temporary loss of consciousness usually caused by a drop in blood flow to the brain. While often harmless, it can sometimes signal serious underlying health issues. In Korea, syncope is a relatively common complaint seen in emergency departments and outpatient clinics, with advanced diagnostic tools and treatment options available at major hospitals.

What is Syncope?

Syncope is defined as a brief loss of consciousness and muscle tone, followed by spontaneous recovery. It occurs when there is insufficient blood flow to the brain, often due to a sudden drop in blood pressure, heart rate, or vascular resistance. Syncope is a symptom, not a disease itself, and can result from various cardiovascular, neurological, or metabolic conditions.

Symptoms

• Sudden fainting or collapse
• Lightheadedness or dizziness before fainting
• Blurred vision or tunnel vision
• Nausea or sweating
• Pale skin
• Confusion or fatigue after regaining consciousness
• A brief period of unconsciousness, usually less than a minute

Causes

Syncope is typically classified into three main types:

1. Vasovagal (neurocardiogenic) syncope – most common and usually benign
   • Triggered by stress, fear, pain, or standing for long periods
   • Causes sudden drop in heart rate and blood pressure
2. Situational syncope – occurs during specific actions
   • Examples: coughing, urination (micturition syncope), swallowing
3. Cardiac syncope – caused by heart-related issues
   • Arrhythmias, structural heart disease, heart attack
   • More serious and potentially life-threatening
4. Orthostatic hypotension – drop in blood pressure upon standing
   • Can be due to dehydration, blood loss, medications, or autonomic dysfunction
5. Neurologic causes – seizures, stroke, or transient ischemic attack (TIA)

Risk Factors

• Age (more common in older adults)
• Dehydration or fasting
• Prolonged standing
• Heat exposure
• Certain medications (e.g., antihypertensives, diuretics)
• Heart disease
• Autonomic nervous system disorders

Complications

• Falls and injuries from sudden collapse
• Recurrent episodes affecting daily activities
• Risk of cardiac arrest (in cardiac syncope)
• Psychological distress (fear of fainting)

Prevention

• Stay hydrated
• Avoid prolonged standing or sudden position changes
• Identify and avoid known triggers
• Wear compression stockings (if prone to orthostatic hypotension)
• Treat underlying medical conditions
• Use caution with medications affecting blood pressure or heart rhythm

Treatment Options in Korea

1. Diagnosis

Korean hospitals offer comprehensive diagnostic tools to identify the cause of syncope:

• Medical history and physical examination
• Electrocardiogram (ECG) – to detect arrhythmias
• Echocardiogram – to evaluate structural heart issues
• Holter monitoring – 24–48 hour ECG monitoring
• Tilt table test – assesses response to position changes
• Blood tests – to check glucose, electrolytes, anemia
• EEG or brain imaging (CT/MRI) – if neurological causes are suspected

2. Treatment

Treatment depends on the underlying cause:

• Vasovagal syncope
  • Education, increased fluid/salt intake
  • Physical counter-pressure maneuvers (e.g., leg crossing, muscle tensing)
  • In rare cases, medications like midodrine
• Orthostatic hypotension
  • Adjusting medications
  • Increased fluid and salt
  • Fludrocortisone or midodrine
• Cardiac syncope
  • Treat underlying arrhythmia or structural problem
  • May require pacemaker or implantable defibrillator (ICD)
• Neurologic syncope
  • Treated based on specific condition (e.g., epilepsy)