Tuesday, January 24, 2017
“Tonight, Governor Dayton briefly fainted after speaking for about 40 minutes. He quickly recovered, walked out of the Capitol, and returned home. EMTs joined the Governor there, and performed a routine check. He is now spending time with his son and grandson. The Governor will present his 2017 Budget tomorrow at 11:15am, as planned. Governor Dayton and his entire staff thank the people of Minnesota for their outpouring of support and concern.”
Let us begin with the facts. Being unconscious is never normal. The definition of fainting is temporarily being unconscious and the medical term is syncope. This describes a situation where the brain loses its blood supply for a short period of time. In some people, this can be normal physiology, like when medical students sees their first autopsy, or a diabetic whose blood sugar drops too low. As people get older, the concept that a fainting spell is a minor event is an alternative fact. In older patients, and governor Dayton at age 69 is older, people who faint should seek emergency care to find out why and potentially prevent future catastrophe.
To be awake, the body needs to deliver oxygen and glucose to brain cells by adequate circulation. Any disruption of that blood and nutrient supply may lead to a loss of consciousness, either temporarily, where the body repairs itself, or permanently. There are many causes from heart rhythm disturbances to dehydration to anemia but each is potentially life threatening or life altering.
Watching the video, the governor reached for a drink of water, developed slurred and unintelligible speech, and then slowly slumped to the floor. If a non-medical observer would see this, perhaps they might remember the American Heart Association stroke ads for FAST… Facial droop, Arm weakness, Speech difficulties, Time to get to the ER. If any are present, call 911 and get the patient to medical care.
In a patient suffering a stroke, where part of the brain loses its blood supply, there is a short time window where treatment to restore blood flow can be started. Whether it is a clot busting drug (thrombolytics) or a rotorooter of an artery (embolectomy), if the treatment window opportunity is missed, the stroke symptoms, like loss of speech, loss of vision,weakness or paralysis may be permanent.
Fortunately for Governor Dayton, his symptoms resolved. If the slurred speech and slumping to the ground were due to a stroke that got better, that would be called a TIA. A transient ischemic attack describes a brain where part of the blood supply has been lost but has then repaired itself, allowing the neurologic deficits to resolve. A TIA is still a big deal, because it may signal the occurrence of a permanent stroke in the near future.
Urgent evaluation is needed to look for a potential cause. Is it because of a clot as a result of atrial fibrillation? or debris from a narrowed carotid artery in the neck? or because of narrowed blood vessels in the brain itself? Risk stratifying the patient can help know whether the patient can be sent home for more tests, or needs to be in the hospital because the risk of a stroke within the next 24-48 hours is too high. Medications can be used to minimize that risk whether the patient is admitted or discharged. The most important step though, is for the patient to show up to be seen. The FAST warning should not be ignored.
The symptoms displayed by Governor Dayton may have been due to excessive fatigue from overwork, dehydration from an illness or there may be other explanations. Regardless, caution is the buzzword when it comes to passing out. While it can be explained, it is never “normal.” It is never wise to ignore the body’s warning signs; nothing positice usually happens.This entry was tagged atrial fibrillation, faint, Governor Mark Dayton, stroke, syncope, TIA