Have you ever come across someone who experienced fainting and sought medical consultation and treatment from a neurologist? If yes, it is probably because of the common belief that fainting happens due to a neurological cause similar to seizures. However, this can be primarily cardiac in nature. Syncope (medical term for faints) is the transient loss of consciousness (T-LOC) with spontaneous recovery which if accurately diagnosed and treated by the correct medical expert i.e. a cardiac electrophysiologist, can be managed very well.
Common faints, also known as vaso-vagal syncope, occurs when there is a temporary drop in the amount of blood that flows to the brain due hyperactivity of normal compensatory reflexes of the heart. It frequently occurs when in the standing position and recovers within 10-15s after falling down. The fall may cause injuries although the episode itself is benign and self-limiting. It is commonly seen in the middle-aged population, predominantly females between 20-40 years of age, but can occur at any age. Use of a head up tilt test (HUTT) is a good way to confirm the diagnosis, although the history of the episode remains the most important point aiding the suspicion of this condition. Hydration, use of stockings, specialised counterpressure manoeuvres and very rarely medications is the mainstay of therapy in these patients. Driving remains prohibited for these patients for at least 3 months after these episodes.
The reason why evaluation of these patients is important is because faints can be the presenting feature of more lethal problems. The heart beats at the rate of 50 to 100 beats per minute and in a sequential manner from the upper chamber to the lower chamber. Any disturbance in either the rate or the sequence is called cardiac arrhythmia. More than 10% of people who experience loss of consciousness could be suffering from arrhythmia either primarily or as a secondary phenomenon to an underlying cardiac condition.
Slow heart rate with abnormal sequences leading to faints is episodic, gradually progressive but irreversible. It needs continuous cardiac monitoring for its diagnosis and may need a pacemaker for its treatment. The type and kind of pacemaker is usually subject to evaluation made by an electrophysiologist.
Increased heart rate with abnormal sequences leading to faints is called sudden cardiac arrest. The first episode by itself can cause fatalities. The worry remains that they may not survive to reach the hospital since blood flow to major organs is cut off almost immediately and starts leading to irreversible organ dysfunction within minutes ; In such circumstances, it is critical that the person next to them recognises the signs of such a faint and is able to administer resuscitation to the patient maintaining blood flow to the brain and heart. These signs include heavy breathing, lack of normal responsiveness, and absence of a pulse. CPR is an emergency procedure that combines chest compressions to manually restore blood circulation and defibrillation to restore rhythm. There are standard courses for citizens to participate in to learn this where training to recognise these events, call for help and manage the patient till help arrives can be provided. Housing societies and companies should have regular sessions for CPR training for their residents and employees along with procurement of defibrillators for such emergencies. More the number of people trained to do resuscitation, more the chance that there is a trained person in the vicinity of the patient who faints; a so called ‘Herd Immunity against sudden cardiac arrest’.
Once in the hospital, these patients need specialised cardiac electrophysiology testing and management by mapping and defusing short circuits in the heart supported by implanting cardiac defibrillators to protect against repeat episodes. These are complex diagnostic and therapeutic procedures done at specialist tertiary care centres by trained cardiac electrophysiologists.
The ‘faint’ therefore can be a benign episode or a fatal one. There is a need therefore to get every episode evaluated for by a cardiac electrophysiologist in order to ensure that optimal management is provided to the patient. It is important to remember that syncope or fainting can be the first symptom of an underlying serious cardiac problem and if unrecognized can potentially lead to sudden cardiac arrest. Hence, while it is important to consult the correct medical expert, it is equally crucial to report fainting in the first instance.
“The only difference between syncope and sudden is that in one you wake up. (1)
Dr. Deepak Padmanabhan
DM(Cardiology), Fellowship in Cardiac EP & Advanced Adult Cardiology (Mayo Clinic,Rochester, USA) Asst. Professor, Jayadeva Institute of Cardiac Sciences & Research, Bangalore
1) Engel GL. Psychologic stress, vasodepressor syncope, and sudden death. Ann Intern Med 1978; 89: 403-412.
12th April 2021
So many drugs, so many symptoms, so many protocols. Here's the one thing that works across the globe. That shows favourable results everywhere. ~Dr Kinjal Goyal
Changing dates, an evolving virus and shifting realities: What is the one thing that is showing favourable results worldwide?
Take a moment to visualise a metaphysical plane. See it as having a vertical and horizontal axis. Now place yourself at the centre and look around you. In the same time frame, people are doing and believing different things, at different places. If you see the change in perspective and behaviour along the various different time frames, you'll notice a stark difference too.
Let me simplify this. What we knew about the Novel Coronavirus at the beginning of 2020 defined our reaction to it and gave us a new normal. As time changed, our collective understanding and reactions changed too. This understanding though, is not concrete and the variable nature has led to people believing in very different things from each other, again affecting reactions internally. In short, we have a heterogeneous understanding of a disease that, although globally homogeneous, is changing rapidly.
New normals and paradigm shifts are hard enough if one has to experience them once. This constantly changing 'normal' is not allowing minds to rest and fatigue is setting in, either imploding or exploding across the world.
How does one step on the brakes and accelerator of a car at the same time and expect a smooth ride? Well that's the situation people are in today. At the height of the first wave of the pandemic, people thought that complete lockdowns were depressing. They missed their friends and the stimulation of human interaction. The second wave has brought about so many variables though, that the simplicity of the first wave now feels like a safer space. With some people who have had the infection, some vaccinated, some with just the first dose (again of vaccines that we are fervently hoping will work well in the long run), new symptoms and new variants, the treatment protocols are changing rapidly. 'To give or not to give' is the question that doctors are asking for the most used drugs. The whole confusion and the evolution of the virus and treatment will probably be clear a decade down the line when everything falls into some perspective, albeit in retrospect.
For now, there is only one thing that has shown similar positive results across the world. Kindness. Call it sympathy, empathy, understanding, patience or by any other name. Kindness towards oneself and others is what is keeping things bearable. When one decides simply not to cause any harm knowingly, a large part of the chain of transmission breaks. Care, compassion and kindness are underrated and written off as words from some book based on Buddhism. Kindness is, in fact, the simplest, and yet most effective tool we have right now.
Take a day to figure it out for yourself. Start by being kind to yourself. Eat well, sleep well and exercise. Read good material and incorporate joyful activities in your day. Now be kind to others. Offer whatever help you can to everyone around you. If someone is infected and quarantined, ask what they need. If someone seems anxious or low, talk to them. Help them recover. If your friendly neighbourhood fruit and vegetable vendors are struggling, offer financial help. Every small bit counts. Not stepping out when not needed is also an act of kindness. Helping out hospitals in your locality with whatever you can is also kindness. The possibilities are endless. You simply need to tune in to the thought. The actions will flow.
Nothing can be larger than the power of the collective kindness of humanity. Not even a deadly virus. Think about it.
Dr. Kinjal Goyal
11th Feb 2021
Year 2020 -An unforgettable Year in the Calendar of our Lives because of Covid -19 pandemic. To hate it and to wish it away, would mean that we are letting go of the opportunity to admit the crucial lessons it taught us. To name a few they will be –to know that work will go on with or without you, there is life in stillness too, time moves on, no one’s indispensable, family is more important than work& career and above all 2020 taught us that we have all become a part of Rat Race which was halted within minutes by a filament of RNA non-visible to naked eye. It also taught us patience, empathy, sharing, caring, living with minimum- realizing we don’t need soo much.
We are survivor of challenges, we thrived through the worst, we healed from losses and we have adapted like never before. These are the great lessons from the great teacher 2020.
A change of date or year will not make all the problems vanish, it will change when our mind set changes. We lookback at 2020 with utmost respect and honor.
Most importantly offer immense gratitude, as it is the gratitude that puts us in place of abundance and shifts our focus on what we have, rather than what we don’t have.We have to accept the fact that we have evolved and matured and grown at another level altogether within just a year.
As a doctor 2020 has made me adapt changes like never before. I understood the importance of use of technology in order to reach out to my patients, to be connected to them, to diagnose and treat them. Instead of in-person clinic, I learned to make a diagnosis with video/tele consult. The diagnostic equipment of pulse oximeter, digital BP apparatus, glucometermade their household presence.
The most important diagnostic equipment which found its place in clinical practice are single lead ECG, AliveCorKardia and Apple watch.I take this forward in 2021 with a mindset that these devices have a huge place in clinical cardiac practice,alongwith setting up Remote/Home Monitoring for patients implanted with Cardiac devices. Remote Monitoring is a way for the patients implanted with heart device to communicate with doctor’s clinic using a small monitor, potentially reducing the number of times of travel to doctor’s clinic for a check of implanted device.
Another Slogan for 2021 is a campaign for prevention of Sudden Cardiac Arrest (SCA) which is a life-threatening emergency that occurs when the heart suddenly stops beating. As a result, blood no longer is pumped throughout the body, including the brain. The person suddenly passes out, loses consciousness and appears lifeless.It strikes people of all ages who may seem to be healthy, even children. SCA leads to death if no action is taken within the first 6 minutes.
We have talked a lot about CAD and heart attack for years but no one has thought to discuss the more fatal, more dangerous condition of SCA.
It’s a common misconception that SCA and Heart Attack are the same thing. In reality, they are quite different.While a Heart Attack is described as a “plumbing problem,” SCA is more of an “electrical problem” that stops the heart.
Unfortunately, only 1/3rd of SCA victims receive Cardio Pulmonary Resuscitation (CPR) from bystanders and fewer than 5% of victims are treated with automated external defibrillators (AEDs) before Emergency Medical Services arrive at the scene. But for every minute that passes without CPR and defibrillation, the chances of survival decrease by 7-10%. As a result, only 10% of victims survive. Yet survival rates could triple if more people knew what to do when SCA strikes. In fact, tens of thousands of additional lives could be saved each year if bystanders acted quickly.
Why don’t more people know and use these fundamental lifesaving skills? It is soo wonderful to Save A Life. Well, my aim for 2021 would be to make “SCA awareness” a campaign and spread the learning about CPR and importance of having AED at all places where there are fire extinguishers.
I salute and honor 2020 and with this mindset I enter 2021………
15th Jan 2021
We enter into this year with new hopes and wisdom from 2020!
We welcome you all into it and wish you best of health, smiles and content.
Needless to mention, we do have a lot of expectations from 2021, and let's hope all are met.
2020 has made us realize quite obvious aspects and facets of life which behind the veil in our day to day busy-ness in life.
We suffered at the hands of the pandemic, either ourselves or our beloveds and friends.
We realize this like never before that Yes we are just,
like some passing moments in the scale of time,
Humanity is resilient and surviving, and we are recovering and healing from the damage.
On the brighter side we did realize that we actually need less than our estimates, family/friends are our real treasures, get togethers/meetings can happen with almost equal fun and learnings with technological aids.
We wish all of you a wonderful time in 2021!
1st Jan 2021
I am Sick of 2020……Get rid of it…..
We will never forget this Year, but to hate it and to wish it away, would also mean that we are letting go of the great opportunity to admit the crucial Lessons 2020 has taught us…… e.g. Patience, Empathy, Living with Minimum- we don’t need soo much.
More so it taught us that there is Life in Stillness, Time moves On, No One’s indispensable, Family is more important than Work and Career and above all it taught “Love Yourself”, You are important, give Yourself time and priority, Life is passing on without You giving yourself a Chance to Live. Whatever You want to do, do it today, do it now because this is Your moment, live it to the fullest.
We are survivors of challenges, we thrived through the worst, we healed from losses and we have Adapted like never before. These are the great lessons from great teacher 2020.
A change of Date or Year will not make all the problems vanish, it will change when Our mind set changes and that is not by saying I hate 2020 rather replace it to “Hey I learned a lot of lessons in 2020”, and there are crucial life lessons learned.
To grow & to evolveWemust befriend pain and We must befriend challenges.
If We are Brave, then Lookback at 2020 with utmost respect, honor and most important immense Gratitude as it is the gratitude that puts us in place of abundance. Gratitude shifts our Focus on what we have, rather than what we don’t have.
Look how much we have Evolved and matured and grown at another level altogether within just a year.
I salute and honor 2020 and with this mindset I enter 2021………