Sports disease: syncope
Syncope is a transient disturbance of consciousness and loss of consciousness due to a temporary reduction in cerebral blood flow or a change in blood chemistry. It is understood that approximately 25% to 30% of healthy young men have experienced syncope; it is not uncommon for athletes to have fainting during or after exercise, which often occurs during intense training or intense competition or after competition. The risk of syncope is not a cause of syncope, but a fracture or trauma caused by a sudden fall of syncope. The special circumstances of the movement such as the air, the underwater and the plateau, and the rapid changes in speed, strength and position during exercise, sudden loss of consciousness can lead to serious consequences such as head trauma, drowning and suffocation. These consequences far exceed the harm of syncope itself. Different sports have different requirements for the human body. For example, the long-term endurance state and the rapid change of body position, sudden increase in chest pressure, or closed air movement exert strong stress on the mental and cardiovascular systems, not only stimulating the diseased heart, but also A healthy heart is also a huge shock. 
(a) common causes
1. Human brain weight accounts for 2% of body weight, cerebral blood supply accounts for 1/6 of cardiac output, brain oxygen consumption accounts for 20% of systemic oxygen consumption, and the critical value of cerebral blood flow needed to maintain consciousness is every minute. 30ml/100g, syncope can occur when cerebral blood flow suddenly drops below the critical value. 
2. Changes in blood chemistry such as hypocapnia or hypoglycemia can also cause loss of consciousness. Regardless of the cause of the decline in blood glucose levels, there may be symptoms of autonomic nervous system activation and epinephrine release. When blood glucose is lowered to a low level, the brain decreases glucose uptake and the ability to use oxygen decreases. 
3. The occurrence of syncope during or after exercise is related to exercise programs, training level, physical condition, age, and the surrounding environment. Weightlifters can achieve intramuscular pressures of up to 21.3 to 29.3 kPa (160 to 220 mmHg) during weightlifting, preventing the filling of the left ventricle, resulting in reduced cardiac output, blood pressure down to 3.33 to 6.67 kPa (25 to 50 mmHg), and Reduced blood flow, a brief syncope. Practitioners who perform short-distance and long-distance running, as well as walking and cycling practitioners suddenly stop after intense training and competition, blood stagnates in the musculoskeletal muscles of the lower extremities, and there is a sudden decrease in returning blood volume, causing gravity shock. Such syncope often occurs. In young practitioners or practitioners with poor training levels and no competition experience. 
Vascular decompression syncope, also known as simple syncope, can occur in normal people, the incidence of the most common type of syncope. Before the onset of emotional instability or a strong mental stimulation and other factors, causing arterial pressure and the body's musculoskeletal resistance decreased, the amount of cerebral blood perfusion reduced syncope. Young female athletes and newly recruited players participate in large-scale competitions. Pre-match tension can easily promote the occurrence of this disease. Athletes' recovery from injury and illness, excessive fatigue, and sudden participation in heavy-intensity training and competitions after the suspension are prone to this type of syncope. 
5. Practitioners with orthostatic hypotension syncope (orthostatic) occur most often when the level suddenly changes to an upright position, due to sudden changes in body position, muscle pumps and vascular regulative dysfunction, resulting in a sudden drop in blood volume and Decreased arterial blood pressure occurs with transient cerebral ischemia, which can occur in the standing position after the completion of the swimming competition. 
6. Paroxysmal muscle weakness, also known as sudden weakness. A decrease in the central nervous system response threshold causes temporary damage to the extremities of the extremities and trips. This syncope occurs in the rowing athletes. 
7. Abrupt primary loss of consciousness, often occurring after intense competition and heavy intensity training, occurs because of the lack of oxygen in the brainstem reticular tissue, and it is different from the distribution of gravity blood volume and syncope due to retinal vasodilation. Hypocapnia causes abnormalities in the direction of nerve conduction and syncope. This kind of syncope occurs during long-distance races. 
8. Loss of consciousness in diving and underwater swimming is the main cause of sudden death. The closed ventilation and pre-dive hyperventilation is to prepare for the closure of the air. Hyperventilation causes excessive air to enter the alveoli, which reduces PCO2 in the body and leads to alkalosis. When the PO2 of the arterial blood decreases to a certain extent, the brain tissue does not work and loss of consciousness occurs. Muscle relaxation, apnea (suffocation) and spontaneous breathing movements, inhalation of a considerable amount of water can lead to drowning death. The processes that may be experienced are: hypoxia, loss of consciousness, muscle relaxation, apnea, inhalation of water, and finally sudden death. 
9. After a long period of strenuous exercise, hypoglycemia caused by blood glucose consumption in the body is more common in long-distance running, marathon, long-distance skiing, skating and road cycling. People with a history of organic or functional hypoglycemia are prone to induce hypoglycemia when exercising. 
10. Cardiac syncope can occur in sports such as football, basketball, cycling, tennis, ice hockey, marathon and jogging. Young people and middle-aged and old people have occurred. Middle-aged people are more common. During intense exercise, myocardial oxygen demand increases, causing myocardial ischemia in narrow coronary insufficiency. In addition, sports can stimulate the increased sensitivity of the arterial wall or increased secretion of catecholamines, causing coronary artery spasm produces myocardial insufficiency, especially after strenuous exercise myocardium is in a special vulnerable period, myocardial perfusion instability, immediately shower or shower will Cause myocardial ischemia, cardiac output decreased primary cerebral insufficiency and syncope occurred.
Exercise can trigger arrhythmias in people without organic heart disease, such as transient syncope during paroxysmal tachycardia. People with aortic or sub-valvular stenosis often have syncope during exercise or manual labor. Congenital Heart disease can cause syncope due to obvious arterial hypoxia after exercise. 
11. Brain syncope occurs in the cerebral vascular congenital malformations, atherosclerosis and cervical spondylopathy practitioners and coaches, exercise when the blood vessels can occur extensive ischemia and syncope occurs, people with high blood pressure to participate in fierce Exercise can cause cerebral arterial spasm, edema, and loss of consciousness. 
12. Practitioners suffer from heat stroke and fainting. Long-distance training and competition in hot summer are prone to syncope, especially in summer when there is no wind or high humidity conditions, when the body produces more heat during exercise, this time through evaporation, convection, conduction and radiation can not be effective Dissipate too much heat in the body and increase body temperature. In addition, blood loss in the brain and loss of consciousness are caused by a decrease in blood volume in a large number of sweating cycles. Heat stroke faints in sports such as long-distance running, marathon, cross-country running, cycling and football. Athletes have low training levels and fatigue is prone to heat stroke. 
(b) Diagnosis
Syndromes during or after exercise are acute neuropsychiatric symptoms caused by different causes. The diagnosis of syncope is based on the history and signs of the attack, especially the onset, progression, and recovery of the episode, including seizure triggers, occasions, posture, presence or absence of prodromal symptoms and sequelae. Signs of seizures are very important for diagnosing the cause of syncope, such as face color, blood pressure, pulse, respiration, heart rate, heart sounds, etc., and conditions are available for electrocardiogram, electroencephalogram or blood glucose examination. 
Vascular decompression syncope There are obvious seizure triggers such as emotional instability, fatigue, pre-onset prodromal symptoms such as sweating, runny nose, and bradycardia. These symptoms last for tens of seconds to several minutes after the loss of consciousness. The blood pressure drops, the pulse slows, and the loss of consciousness takes about several seconds to tens of seconds to wake up on their own. 
2. Orthostatic hypotension syncope occurs in the horizontal position of the sport suddenly turned upright position, sudden loss of consciousness, no prodromal symptoms, symptoms and signs of seizures with vascular decompression syncope. 
3. Paroxysmal weakness can be seen in rowing competition athletes. The collapse occurred a few minutes after the completion of the game, followed by a significant weakness, and the syncope lasted only a few seconds. 
4. Emergent primary loss of consciousness Athletes with low levels of training have poor adaptability to the cardiovascular system, unable to adapt to high-intensity exercise loads, prone to hypoxia and hypocapnic syncope, confusion before the onset, loss of consciousness The degree of darkness, gray complexion, corneal reflexes disappeared, syncope lasting longer, after waking up can not remember the scene at the last moment of the game, after waking up with neurological symptoms such as aphasia.  5. Loss of consciousness when swimming underwater and diving. Inexperienced underwater swimming and divers have a risk of loss of consciousness when completing a longer distance dive, and the mortality rate is high when loss of consciousness occurs. The survivors had loss of consciousness, difficulty in breathing, cyanosis, and blisters in both lungs. 
6. Cardiac syncope force is often the cause of seizure, seizure and position have nothing to do, have heart palpitations, chest pain and other symptoms, attack pale pale with purpura, dyspnea, jugular vein distention, heart rate, heart sounds and pulse changes, ECG have many Abnormal performance. 
7. Hypoglycemic syncope Prodromal symptoms such as weakness, tremors, sweating, tachycardia, hunger, and behavioral fluctuate, syncope takes longer, and consciousness can be restored after sugar supplementation. 
8. Brain syncope Syndromes occur with headache, dizziness, vomiting, convulsions, sometimes accompanied by aphasia, mild hemiplegia, impaired vision, or blindness. 
9. Heatstroke Fainting The practitioner experiences dizziness, chest tightness, thirst, nausea, vomiting, and dry skin during the training and competition in hot summer conditions. Severe persons develop fainting. Body temperature can be as high as 40 °C or more, pupillary shrinkage, pathological reflexes. Some are pale, clammy skin, weak pulse, and blood pressure drop.
(c) Treatment and Prevention
1. Processing
(1) General treatment Patients with syncope should be placed in supine position or elevated position of lower limbs, which can increase cerebral blood flow. Loosen tight clothes and turn your head to the side to avoid falling behind the tongue and blocking the airway. Facial and neck cold and wet compresses, such as low body temperature covered blankets. If necessary, acupuncture or odor-stimulating ammonia smell to the patient. 
(2) Etiology Treatment Vascular decompression syncope and erectile hypotension syncope can be alleviated by the above treatment. 
(3) Paroxysmal weakness and sudden primary loss of consciousness Give oxygen and the above general treatment. 
(4) Underwater swimming and diving awareness Loss of consciousness often occurs within 2.5 minutes of consciousness and should be promptly rescued. Recover the airway patency at the fastest speed, immediately open the mouth and pull the tongue out of the mouth so as not to block the airway, and drown the head of the drowning person to pour water, and then continue artificial respiration. At the same time, when the heartbeat stops, an external cardiac massage is performed at the same time. The endotracheal intubation is performed with positive pressure oxygen and cardiac pacing, and respiratory stimulants and intracardiac injections are given at the same time. 
(5) hypoglycemia syncope intravenous glucose. 
(6) Cardiac syncope Immediately oxygen, ECG atrioventricular block diagram when injected subcutaneous atropine. Such as intravenous ventricular tachycardia lidocaine. The treatment of acute left heart failure is cardiac and diuretic. Acute myocardial infarction given pain, sedation, anti-arrhythmia, anti-shock or anti-heart failure treatment. Cardiogenic syncope is safely transported after on-site first aid. 
(7) Brain syncope On-site rescue measures include oxygen, maintaining airway patency, reducing blood pressure, and reducing intracranial pressure. Intravenous glucose injection, intramuscular injection of reserpine or magnesium sulfate (deep intramuscular injection), combined intramuscular injection of paraaldehyde when convulsions. 
(8) Heat stroke Fainting Move the heat stroke fainting person to a cool, well-ventilated place to rapidly cool down. Bring the skin to redness with ice water, cold water, or alcohol rubbing bath. Put ice packs in the head and large blood vessels distribution area. Conditionally administer intravenous 5% glucose saline. . 
2. Prevention
(1) Adhere to the training principles of the scientific system to avoid the occurrence of excessive fatigue, excessive stress and other sports diseases. 
(2) Those who participate in long-term intense sports activities must be trained practitioners. 
(3) The recovery of the disease and the older persons participating in the exercise must be performed according to the exercise prescription. 
(4) Avoid long-term training and competition in summer with high temperature, high humidity or windless weather conditions. 
(5) Long-distance exercise should be supplemented with sugar, salt and moisture. 
(6) It is not advisable to swim long distances under closed air. Underwater swimming should have safety supervision measures. 
(7) Athletes should perform regular physical examinations, especially before major competitions and heavy training. 
(8) For those who have experienced syncope, they should do a thorough examination to clarify the reasons and avoid syncope. 
(9) Practitioners and coaches should have the ability to prevent and simply deal with syncope in sports.
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