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Neurología Mancha-Centro

Servicio de Neurología del Area Mancha Centro - Hosp. General Mancha Centro y Hosp. General de Tomelloso

Blog de Neurologia Post New Entry

RECOMENDACIONES PARA EL PACIENTE CON SINCOPE REFLEJO O NEUROMEDIADO

Posted by Enrique Botia Paniagua - Jefe de Neurología HGMC on October 5, 2016 at 5:05 PM

  

INFORMACIÓN:

  •  El síncope consiste en una pérdida de conocimiento súbita y transitoria con pérdida de tono postural y recuperación espontánea, sin déficits neurológicos y que es debida a fallos en la perfusión momentánea de todo el cerebro que se produce por una bajada brusca de presión arterial o de la frecuencia cardíaca.
  • Su médico de atención primaria ya debería haber descartado que usted no padezca ninguna afección cardíaca que pueda inducir a síncopes de origen cardíaco.
  • El síncope neuromediado o reflejo es una patología benigna en la que el síncope es producido por una reacción anómala de la presión arterial o la frecuencia cardíaca a un estímulo determinado como puede ser el estrés, la angustia, el miedo, el dolor, la fobia a la sangre o instrumentación, la bipedestación prolongada, ambientes calurosos, la tos, el estornudo, la defecación, la deglución, la micción, tras una ingesta de alimentos copiosa, la risa, tras un ejercicio físico, el levantamiento de pesos o la presión sobre la región anterior y lateral del cuello u otros desencadenantes menos reconocibles.

 

FACTORES A REALIZAR:

  •  Se recomienda una adecuada hidratación (2-3 litros al día), preferentemente de agua fría y un consumo adecuado de sal con alimentos como frutos secos, gazpacho, jamón curado… (salvo que usted tenga problemas de hipertensión arterial mal controlada).
  • Realizar ejercicio físico moderado (aeróbico) a diario o al menos tres veces por semana.
  • Es muy útil aprender técnicas de relajación y control respiratorio.
  • Si debe someterse a alguna prueba médica como extracción sanguínea, extracción dentaría, etc… debe hacerlo siempre estando tumbado.
  • Previa a la pérdida de conocimiento muchos pacientes tienen síntomas llamados SÍNTOMAS PRODRÓMICOS como palidez, sudoración, palpitaciones, bostezo, dilatación de la pupila, nublamiento visual, aturdimiento, etc… Debe usted aprender a identificar estos síntomas. Si usted nota alguno de ellos debe:
    • Tumbarse rápidamente y levantar las piernas por encima del nivel de la cabeza. No volver a incorporarse de nuevo hasta que haya cesado el malestar y hacerlo de forma lenta.
    • Hacer maniobras de contrapresión como apretar los puños, entrelazar fuertemente las manos y tensionar los brazos extendiéndolos con fuerza, sentarse en cuclillas, sentarse comprimiendo el abdomen o bien cruzar las piernas tensionando los glúteos.
    • Estas maniobras, realizadas en el momento justo, pueden evitar que se produzca un síncope en muchas ocasiones.

 

 

 

    • En algunos casos son recomendables las medias de compresión en las piernas o las fajas de compresión abdominal.
    • Aquellos pacientes jóvenes con síncopes producidos por estar en bipedestación prolongada pueden hacer entrenamientos de basculación prescritos desde atención primaria consistentes en mantener posturas verticales forzadas cada vez durante más tiempo hasta conseguir tolerarlas.

 

FACTORES A EVITAR

  • Si usted tiene algún desencadenante específico que le produzca los síncopes debe intentar evitarlos en la medida que pueda. En general se recomienda evitar:
    • Factores hipotensores como vómitos, diarreas, anemia, fiebre, drogas y alcohol.
    • Ambientes calurosos, sobrecargados, ruidosos y comidas copiosas rápidas.
    • Maniobras de Valsalva (aumento de la presión intratorácica).
    • Los cambios posturales bruscos (levantarse del sillón o de la cama rápidamente…;).
    • Ejercicio físico excesivo, especialmente esfuerzos importantes en series cortas (anaeróbico).
    • Bipedestación prolongada. Si es inevitable se debe permanecer haciendo contracciones musculares (miembros inferiores, abdomen,…;).
    • Además su médico de atención primaria debería reducir, sustituir o eliminar determinados fármacos para la hipertensión arterial (Betabloqueantes, diuréticos, alfa-bloqueantes), diuréticos, antidepresivos tricíclicos e inhibidores de la monoaminoxidasa, tratamientos para la enfermedad de Parkinson, antipsicóticos atípicos e inhibidores de la 5PD.
    • Tratar la tos o prevenirla en caso de que sea su desencadenante de síncopes.
    • Evitar el estreñimiento.
 
Fecha: 5-10-2016.  ©  Dr. Pablo del Saz Saucedo
Servicio de Neurología del Hospital General La Mancha Centro

 

 

Categories: Cerebrovascular

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