Welcome, my name is Dr. Warrick Bishop. I'm a cardiologist, 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 is Dr. Ulrich Bishop and welcome to my podcast and videocast station. And thank you so much for taking the time to listen. I really do appreciate it. Today, I'd like to talk about blackouts. Well, blackouts are also called syncope, and syncope means pause. For any of you music lovers out there, you would know that syncopation is a style of music with lots of pauses in it. So syncope or blackouts are interchangeable. Well, let's think about how we would talk about syncope or blackouts, and the way to do it is to break it down into what may be causing. people to have one of these terrible turns. And you can imagine that a blackout out of the blue is a disaster. Imagine you had a bit of osteoporosis and fell over and broke a hip. That's a terrible outcome. Imagine you were driving and blacked out. Again, unimaginable and a terrible problem. So how do we start to evaluate blackouts and how do we think about them and, well, what's their origin? Well, I think it would be reasonable to break them down into heart causes, brain causes, blood pressure related, and related to nerves. So let me run through that and just give you an overview of how I would approach an individual who came and saw me with blackouts and how I'd start to break all that down. Well, of course, when we think about the heart causing blackouts, we think of valves, maybe too tight. and not letting enough blood out. So we would want to get an echocardiogram and see what the valves are doing. A very tight aortic stenosis, which is the main valve leading out of the heart, can lead to blackouts. The heart can also have funny rhythms. And funny rhythms, of course, can go two ways. They can be too fast, and they can be too slow. If a funny rhythm is too fast, it can arise from either the top part of the heart, we would call that an atrial tachycardia, atrial because it arises from the top part of the heart, tachy referring to fast, cardia referring to heart, so an atrial tachycardia, but you can also have ventricular tachycardia. Generally, an atrial tachycardia, the heart might just might tear off at a rapid rate, and really through lack of blood flow. the individual will pass out, possibly if they're moving from a sitting to standing position. This is what could exacerbate it. When it comes to ventricular rhythms, which are ventricular tachycardia or ventricular fibrillation, these are very sinister rhythms with poor prognosis more often than not. And with their onset, the patient will blackout immediately. So it is important to evaluate the individual in all ways to figure out if ventricular tachycardia or ventricular fibrillation are the underlying cause of this individual's blackout. Next, we can think about the brain leading to blackouts. Well, of course, a stroke, a major stroke could lead to a blackout immediately. And this could be a stroke either through lack of blood flow, i.e. a clot blocking an artery, but it could also be related to a large bleed or artery rupturing and blood streaming out of that artery into the brain tissue. So stroke could cause a blackout. One of the other causes can be seizures or epilepsy. And this is important as... Sometimes we don't get too many clues. Of course, in people who've had previous brain injury, for whatever reason, seizure as a possibility is a more likely diagnosis, but sometimes it's very hard to evaluate potential seizure risk. And so it's not uncommon that we might evaluate individuals for heart-related rhythm problems and seizure-related brain issues simultaneously. The heart, we talked about fast rhythms, we also need to consider slow rhythms because the heart can miss beats for a number of times and this would be called a pause or a heart block. So fast heartbeats, slow heartbeats and brain problems can all lead to symptoms, a blackout, which appear very similar. As we try and understand whether it's a fast heartbeat or slow heartbeat, sometimes we'll put small recording devices in under the skin. These are called loop recorders because they loop and loop and loop and keep recording every beat, every second of every minute of every hour of every day. And as they keep recording... As soon as an irregularity appears, they store that irregularity so we can interrogate it later. When it comes to brain seizures, we look to do what's called electroencephalographs, which are, if you like, ECGs of the brain, trying to assess how the brain electrical activity is working. And this can give us a clue towards seizures. One of the other things that can give rise to blackouts is blood pressure. and blood pressure dropping, particularly if someone's on medication, for example, and that medication's just been increased, they could be at risk of blacking out, particularly if that person has been, for example, dehydrated. Not drinking and working hard in the garden could lead to that. But blood pressure can also be a problem in certain neurological conditions, such as Parkinson's disease, where individuals don't have as good a automatic control of their blood pressure responses and in this situation it can be very problematic. Parkinson's patients for example can have quite significant issues with mobility but imagine how troublesome that is if on top of their difficulty with mobility they're also confronted with blood pressure dropping and the possibility therefore of blacking out. The last way that people can black out is I'm going to call through nerves or a simple faint now many of us may well have experienced something along these lines if you were to stand in a hot room for too long and you are hungry and if you're not if you're like not able to move you might eventually get a bit hot and woozy and feel like you need fresh air if you are watching a movie that might be a bit gory and it just made you feel a bit hot and woozy and you think you need some fresh air. This is the beginnings of what we would call a vagal episode. A simple faint. Well, the vagus nerve is the nerve that really supports our parasympathetic nervous system. Well, you may have heard of the parasympathetic nervous system. This is the complementary nervous system to the sympathetic nervous system. Remember, the sympathetic nervous system is the fight and flight response, increasing heart rate, increasing blood pressure, making our eyes dilate, getting us ready to fight or flee. Well, the parasympathetic nervous system is altogether different. This is the one that slows us down, can lower our blood pressure, can lower our heart rate, and can... lower it so much that we can black out. Often we'll feel a bit nauseated with this. We would call the vagal or the parasympathetic nervous system the rest and digest nervous system if you like. So we're concentrating on letting the body do its autonomic things, letting the gut digest, slowing everything down. Well, if you get a profound vagal response and the blood pressure drops and the heart rate drops, people can black out from this. This is really characteristic, as I said, of people who might be standing to attention for too long in the sun or people who watch something that's a bit gory and it turns over their stomach. Luckily, a vasovagal episode can normally be averted and it shouldn't be a cause for someone having their driver's license taken away from them. Blood pressure syncope or blackouts are generally clearly delineated by history. But when it comes to heart and brain blackouts... Often it's the case we do need to hold people's driver's license for a period of time until we've got more understanding of exactly what's going on. And you would imagine that this makes perfect sense. Well, that's about it for me for now on blackouts. We've talked about the heart, the brain, blood pressure and nerves giving rise to blackouts. Nerves probably do it most commonly through simple feints. Blood pressure, huge problem, particularly as people get a little bit older. Brain and heart syncope or blackouts, complicated issue. And sometimes we do need to hold driver's licenses till we know more. Remember the heart can have valves that are a problem or rhythms that are too fast or too slow. And those rhythms that are too fast from the top part of the heart or the bottom part of the heart. And remember the brain, we might see seizures or stroke as a cause for blackouts. Well, I hope you found that informative. I've enjoyed sharing as always. If you have any queries or questions, drop me a note. If you haven't checked it out yet, please check out my new AI bot on my website. We've loaded it up with my knowledge base and we think it's doing an astounding job at answering people's questions. Please check it out. And if you like it, drop us a review and let us know. For now though, again, thank you so much for taking the time to listen. I really do appreciate it. I'm going to wish you the very best. Please 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. It will give you information about risk and what else can be done to be even more precise.
