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Presyncope

Syncope or fainting episode requires immediate medical attention as it is associated with neurological responses in the body. Syncope episdoes are related to the malfunction or altered function of important physiological activities in the body. Syncope is categorized into cardiovascular and non-cardiovascular types depending on the underlying case of ischemia. Presyncope is a precursor to the onset of syncope as the patient begins to experience lightheadedness or dizziness.

Clinical manifestations of presyncope

Presyncope or dizziness is often related to vertigo during clinical evaluation of the patient. Vomiting and nausea are two classical signs indicating the onset of a presyncope episode. In most cases people travelling to higher altitudes and regions of low oxygen concentration experience this. In some cases these symptoms occur because of extreme physical activity, improper nutrition, underlying cardiac condition and also diabetes. Syncope or presyncope is associated with apnea as there is decreased oxygen supply to the brain. Patients experience abdominal discomfort, blurred vision and also headaches during the presyncope episode. Presyncope episodes can be very dangerous during driving as it may lead to accidents. Disorientation is also an important symptom in identifying the onset of presyncope which subsequently leads to syncope.

Diagnosis of presyncope

The diagnosis of presyncope-related episodes is dependent on the identification of underlying cardiac and neurological conditions. Thorough analysis of the heart functionality, respiratory parameters and neurological functions are conducted. In many cases presyncope and episodes of syncope are closely associated with ischemic heart disease. Carotid artery palpation and examination of left ventricular flow are done. Presyncope episode is a warning sign of an impending physiological transition or complication. Cerebral blood flow obstruction caused due to pulmonary embolism is also a major factor for the onset of syncope.

Treatment of presyncope

Presyncope diagnosis is associated with existing medical conditions. Studies indicate that presyncope is also caused due to psychological disorders such as anxiety and panic. The patient is initially examined for underlying cardiac or neurological disorders before treating presyncope. The most common methods of treatment are through diet counseling such as fluid and salt intake. Patients prone to presyncope episodes are advised to avoid sauna, steam showers and also highly populated areas. Medications such as beta blockers, ephedrine, pseudoephedrine, theophylline, sertraline and fluoxetine are suggested for presyncope and cardio-neurogenic syncope conditions.

Tilt table test

Tilt table test is a diagnostic test that is conduced on patients suffering from symptoms such as sudden drop in blood pressure. Patients suffering from symptoms such as fainting spells or severe lightheadedness may be asked to go through the tilt table test to check changes in postural hypotension. The tilt table test can throw light on unexplained fainting spells. During a tilt table test, the blood pressure is monitored with respect to its response to stress of gravity. Syncope is caused by unusual body response to position changes. Patients undergoing tilt table test are connected to ECG-type machine and IV line too. Isoproterenol or similar drugs are used during the tilt table test. It is essential that the physician is informed of any medications such as appetite suppressants and sleeping pills. The patient is monitored in supine position and later in sitting position. Any symptoms of dizziness or vertigo are noted. Abnormal results of tilt table test are indicative of abnormality of blood pressure regulation.


Tadalafil

Tadalafil is a prescription drug to treat ED Erectile Dysfunction. Tadalafil, available in many brand names - such as Cialis, is a second generation selective phosphodiesterase 5 (PDE-5) inhibitor medication. PDE-5 inhibitors work by blocking an enzyme called phosphodiesterase-5 PDE-5. First generation PDE-5 inhibitors like Sildenafil and Vardenafil (Levitra) have a half-life of 3.7 hours typically while the second generation drug like Tadalafil has a half life of about 17.5 hours or more. What this means is that a single dose can have a longer effect. Some studies have suggested the use of this drug for the treatment of other male and female sexual disorders, such as premature ejaculation and female sexual arousal disorder.

Dosage of Tadalafil: Note that alcohol and a PDE5 inhibitors act as mild vasodilators. When mild vasodilators are taken in combination, blood-pressure lowering effects of each may be increased. This combination can enhance the potential for orthostatic signs and symptoms such as an increase in heart rate, decrease in standing blood pressure, dizziness and headache.

Normal dosage is about 10 mg as a single dose a few minutes before the actual event. Its effects last upto 36 hours in some cases obviating the need for more doses in subsequent days.

Contraindication for Tadalafil: Tadalafil or Cialis is contraindicated for patients who use organic nitrates as the concomitant use of the nitrates along with PDE inhibitors can result in abnormal lowering of blood pressure, or dizziness, syncope, or even heart attack or stroke.

Side Effects of Tadalafil:Some patients have reported headache, indigestion, back pain, muscle aches, nasal congestion, facial flushing and dizziness although these effects do not last longer than 24 hours after the administration of the drug.

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Bibliography / Reference

Collection of Pages - Last revised Date: December 9, 2019