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Hello, Great site! Thanks for the wonderful content and insights. I have a question: In reference to near-syncope or syncope, specifically, after a LARGE meal… I think I understand some of the pathophysiology taking place from a basic premise, such that, increased blood needed to aid in digestion, therefore less reserve volume. Then the Pt stands up from the table, theres not enough blood reaching the brain… I know this is a simplistic understanding (I may even be completely wrong), so if you are able to fill in some of the gaps or provide additional insight (i.e. the roll of beta-blockers, hypotension or carotid stenosis), that would be greatly appreicated. Thank you again, Frank Intessimoni feel free to email me
Hi Frank,
You’re on the right track. Syncope is caused by temporary disruption in the blood flow to the brain and this can be achieved via a number of mechanisms. Taking the scenario you presented: A full stomach can cause pressure on the vagus nerve (effecting the heart) and sudden standing requires the body to compensate. This can take a few seconds especially in someone with a diseased cardiovascular system. Beta blockers (and other medications) effect the heart and lower the blood pressure. If your patient has carotid stenosis then the diameter of the pipe the blood is trying to get through has narrowed (depending on how severe the stenosis is) and decreases the normal amount of blood which can reach the heart. When you put it all together and this person quickly stands up then syncope or near-syncope can occur.