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Why did Hilary Clinton and Mike Krzyzewski collapse last week?

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Odd, don’t you think, that Senator Hilary Clinton, about to give a speech in Buffalo last Monday, and then Duke basketball coach Mike Krzyzewski yesterday in Durham, N.C., without any apparent warning, each fell to the floor?

I thought so.

What caused these events?

It’s called vasovagal syncope in the medical world, a vasovagal episode or attack in lay parlance.

It occurs when a complex reflex arc is triggered by anxiety or a sudden change in body position, usually from supine or sitting to standing.

The body’s autonomic (automatic, or not under conscious control) nervous system overreacts to impulses traveling along the vagus nerve to the brain.

This exaggerated response leads to a drop in blood pressure and often a slowed heart rate.

When blood pressure drops, less blood flows to the brain, leading to fainting.

The two causes – neurogenic and positional – are different, but the final common pathway is the same, namely, people faint/pass out/lose consciousness.

In some cases, like Coach K’s, the person appears not to lose consciousness, only muscle tone.

What to do if you see this about to happen, i.e., if someone says they feel woozy or lightheaded?

Sit them down, bend them forward with their head between their knees.

Even better, lay them gently on the ground, and let them come to in their own good time.

No need for a 911 call, no smelling salts, no slapping their cheeks like you see on TV: everyone recovers on their own, without any sequelae.

The only danger is a person’s head hitting something on the way down – that way lies skull fractures and bleeding into the brain.

Same with epileptic seizures, while we’re on the subject of going to the ground: just make sure the person doesn’t hit their head on the way down, or while they’re seizing.

Sticking something in the mouth to prevent biting the tongue is no longer recommended – just leave the person alone.

Again, no 911 call, no heroics.

Less is more.

Thank you, Drs. van der Rohe and Occam, for the excellent consultations.

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  • http://www.myspace.com/welcometobrookhollow Scott

    The Vasovagul thing totally happens to me when I get blood drawn. I can relate.

  • David Mitchell

    My 17 year old daughter has been diagnosed with vasovagal syncope. She has become unresponsive on about 20 occasions over the last 2 years, normally immediately following intense sports (anaerobic) exercise, with her inability to speak (for example) lasting commonly for about 10-15 minutes and on 3 occasions, for 50-60 minutes, despite being in a supine position with feet elevated. She claims she can hear throughout most, if not all of these episodes. These durarions are not the common 1-3 minute syncope episodes. Medication to improve salt retention, increase blood pressure, increasing fluids (70 oz minimum/day) and support stockings have not stopped these episodes from occuring. After several trips to the hospital and even more 911 calls, I had decided that further 911 calls weren’t needed, but her doctor stongly advises to immediately use smellling salts and call 911 after 3 minutes max if she still cannot respond/speak. Any thoughts/suggestions/questions on alternative interventions/causes/directions, etc.?

  • http://paperfrigate.blogspot.com DrPat

    David, there is a type of seizure (and it is very common in adolescent girls, gradually disappearing as they mature) that matches the symptoms you describe. That’s probably why your doctor advises smelling salts (to make sure it’s not a vasovagal syncope episode) and calling 911 after long non-response.

    But from my personal experience, unless you can trigger an episode while your daughter is in the MRI machine, you’ll not find the specific cause. That actually argues for calling 911 — enough emergency trips, and the correct diagnosis (or triggering situation) is bound to emerge.

    There is also a very useful flow-chart that will help you (with your doctor) determine whether your daughter’s fainting spells might not be vasovagal in origin.