The New Straits Times, February 10, 2002
By Dzulkifli Abdul Razak
WHENEVER a festive season approaches, it is worthwhile to repeat a few reminders to ensure a great time. Among these are to keep away from fire-crackers, and not to drink and drive. The risks of indulging in these two "festive" habits are well known but a simple reminder should do no harm.
But this time, as the Year of the Horse kicks in, there are a few new reminders that we could learn from recent international events. One is, of course, the breaking news about the fall of another towering American symbol , the President himself, when he literally collapsed following a brief fainting spell on January 13. We are reminded that "you should not stuff dry pretzels down your gullet and you should pay attention when eating." The relevance of this message to the Chinese New Year celebration is rather obvious on a number of counts. First, though we traditionally do not serve "pretzels", the popular kuih kapit or "love-letters", or any "dry" biscuit could do the trick just as well.
Of course, some might argue that they know better, but so did "Pretz" Bush, and look what happened when he forgot mum's advice to "chew before you swallow." Fortunately, the US is convinced that incident 113 has nothing to do with bio-terrorism, and therefore we do not have to go to war on this one. Choking after eating is in fact a common cause of fainting, an occur-rence called "vasovagal syncope". Essentially, it has to do with the lowering of blood pressure to a point where the brain receives insufficient blood and oxygen, which results in the loss of consciousness, more specifically "vasovagal fainting".
In its most common form, vasovagal syncope is benign. The episode can be triggered by severe pain, stress-related emotions (e.g., depressing news) or situations (e.g., warm, crowded room), and even fear. Though the fall due to loss of consciousness may cause injury, the episode itself is transient and seldom serious.
A more dangerous, but treatable, form is the malignant vasovagal syncope, sometimes described as "neurocardiogenic syncope," and usually involves heart problems. The attack is more likely to occur in a hot environment, especially after a meal with alcohol according to one source (http://www.syncope.co.uk).
The onset may be sudden, but could be preceded by a sense of faintness associated with "presyncope signs" which include nausea, visual disturbance, headache, abdominal discomfort, fatigue, weakness. Some of the presyncopic warnings may last for seconds or minutes, though at times they may be totally absent.
A recent report confirmed by the White House suggests Bush indeed has a heart condition called sinus bradycardia that makes him more prone to fainting when he gags or chokes. A day after the episode, his "resting pulse rate" was said to be well below 60 beats per minute.
In such a case, choking or gagging can induce fainting, particularly triggered by hard coughing. One suspects that this may happen to Bush as he attempted to dislodged the "evil" pretzel. It is now accepted that when there is clinical evidence of abnormal heart rhythm the risk of fainting is higher. A good example is when the heart beats very slowly, that is, bradycardia. Although in general a slow heart beat can be regarded as the sign of a healthy heart, as demonstrated by many athletes with heart rates about 70 beats per minute, anything lower than 60 is considered bradycardia associated with heart problems.
Notwithstanding these, understanding what causes vasovagal fainting, and how to manage it can assist in preventing it. For example, by not standing in one position for a long time, especially in the hot sun. If one has to do so (as in a parade of honour), rock on the feet, forward and backward; and at the same time squeeze the toes rhythmically in your shoes. Where possible stand with the legs crossed, alternately from time to time, or do exercises that could facilitate blood flow to the heart and brain.
And when there are warning signs of syncope happening, immediately sit down. Preferably, lie flat on the back with the legs raised. The purpose is to help the blood flow from the limbs back towards to the heart, so that effective pumping is maintained, including its distribution to the brain. After a while, get up slowly, and if the signs persist repeat the manoeuvres. But shifting from one position to another too fast can cause fainting.
During festive seasons, one immediate consideration is to avoid heavy meals and excess alcohol, as both have been reported to trigger or exacerbate syncope. In this regard, another reminder is also apt: do not take eating for granted, that is, "you should pay attention when eating." In this regard, given that avian flu is now in the air, it is interesting to note that after a bout of flu vasovagal attack can also be a causal factor (http://www.yourdoctorinthefamily.com/advice/adv002.htm). It so happens that a couple of days before the attack, Bush was said to be recovering from a "cold." But what is more interesting is a recent finding by a Hong Kong professor from the Chinese University suggesting the relation-ship between talking, too much and too loudly, and flu. Keeping the mouth open for long makes one more prone to the flu, according to the study. The bug allegedly lodges more easily in the throat and airways to cause the illness as demonstrated in Hong Kong where there is too much "background noise" in places such as restaurants where people talk so loudly. In short, mum's advice not to talk while eating is important.
Last, but not least, is the link between vasovagal syncope and driving. Generally, those who have experienced recurrent vasovagal syncope or prone to the attack should avoid driving and/or operating any danger-ous devices, especially when the precipi-tating factor is "unknown" or "unexplained." On that note, we wish our readers a healthy and a galloping Year of the Horse. Gong Xi Fa Cai.
Recommended site: http://www.nlm.nih.gov/medlineplus/fainting.html
