What is Syncope(Fainting)?
Syncope, also called fainting, is a loss of consciousness and muscle strength characterized by a rapid onset, short duration, and spontaneous recovery. It is caused by decreased blood flow to the brain, usually due to low blood pressure.
Types of Syncope
The type you have depends on the cause of the problem.
Vasovagal Syncope (cardio-neurogenic syncope)
- Vasovagal syncope is the most common type of syncope. It is caused by a sudden drop in blood pressure, which results in decreased blood flow to the brain.
- When you rise, gravity causes blood to build up in the lower part of your body, underneath your diaphragm.
- When this happens, the heart and autonomic nervous system (ANS) work to keep your blood pressure stable.
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Situational Syncope
This only happens in certain situations that affect the nervous system and lead to syncope. Some of these situations are:
- Dehydration
- Intense emotional stress
- Anxiety
- To fear
- Pain
- Hunger
- Alcohol or drug use
- Hyperventilation (breathing too much oxygen and getting rid of too much carbon dioxide too quickly)
- Coughing forcefully, turning your neck, or wearing a tight collar (carotid sinus hypersensitivity)
- Urinating (attenuating syncope)
Postural Syncope (postural hypotension)
- Postural syncope is caused by a sudden drop in blood pressure because of a rapid change in position, like from lying down to standing. Certain drugs and dehydration can lead to this condition.
- It usually has changes in their blood pressure drop by at least 20 mmHg (systolic/upper number) and at least 10 mmHg (diastolic / lower number) when standing.
- Cardiac syncope is caused by a heart or vascular condition that affects blood flow to the brain.
- These conditions can include an abnormal heart rhythm ( arrhythmia), blocked blood flow to the heart because of structural heart disease (the way the heart is formed), blockage of the heart's blood vessels (myocardial ischemia), aortic stenosis, blood clot, or heart failure.
Neurological Syncope
- Neurological syncope is caused by a neurological condition such as a seizure, stroke, or transient ischemic attack (TIA).
- Migraine headaches and normal pressure hydrocephalus are other less common conditions that lead to it.
Postural Orthostatic Tachycardia Syndrome (POTS)
- Postural-orthostatic tachycardia syndrome is caused by a very rapid heart rate (tachycardia) that occurs when a person stands after sitting or lying down.
- The heart rate can accelerate by 30 beats per minute or more. The increase normally occurs within 10 minutes of standing.
- The condition is most common in women, but it can also occur in men.
Unknown Causes of Fainting
Cardiac syncope is caused by a heart or vascular condition that affects blood flow to the brain.
These conditions can include;
- Abnormal heart rhythm (arrhythmia)
- Structural heart disease (the way the heart is formed)
- Blockage of the heart's blood vessels (myocardial ischemia)
- Valve disease,
- Aortic stenosis,
- Blood clot
- Heart failure
Syncopal Attack Causes
- Syncope is a symptom that can be caused by several causes, ranging from mild conditions to life-threatening.
- Many factors, such as overheating, dehydration, profuse sweating, exhaustion, or the pooling of blood in the legs due to sudden changes in body position, can trigger syncope.
- It is important to determine the cause of the syncope and the underlying conditions.
Diagnosis of Fainting
To diagnose the cause of your fainting, your physician will first take your medical history. They will ask you about your symptoms, what you were doing when you passed out, and if you are taking any medications or have any underlying conditions.
Various tests can be used to diagnose the cause of fainting. These tests may include:
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- Electrocardiogram (ECG): An ECG measures the rhythm and electrical activity of your heart using small electrodes. In some cases, you may need to wear a portable ECG machine to monitor your heart's activity over a while.
- Lab tests: Blood tests can help identify conditions such as diabetes, anaemia, or cardiac markers.
- Tilt table test: During a tilt table test, you will be strapped to a special table. Your heart rate and blood pressure are measured as you go from lying down to upright.
- Carotid sinus massage: Your doctor will gently massage your carotid artery, located in your neck. They will check to see if symptoms of fainting occur when they do.
- Stress test: A stress test measures how your heart responds to exercise. Your heart's electrical activity will be monitored by ECG as you exercise.
- Echocardiogram: An echocardiogram uses sound waves to create a detailed picture of your heart.
- Electrophysiology: With electrophysiology, small electrodes are threaded through a vein and into your heart to measure the electrical impulses in your heart.
- Imaging tests: These tests may include a CT scan or MRI, which captures images inside your body. These tests are most often used to examine the blood vessels in your brain when a neurological cause of fainting is suspected.
Syncope Treatment
Perform a detailed medical history and physical examination
Utilize diagnostic tests such as ECG, echocardiogram, or tilt-table test to pinpoint the underlying issue.
Adjusting Lifestyle
Ensure proper hydration levels.
Steer clear of triggers like prolonged standing, dehydration, or extreme heat.
Reduce alcohol consumption and avoid medications that lower blood pressure or lead to dehydration.
Prescribed Medications
Recommend medications tailored to the specific cause of syncope.
This may include medications to regulate blood pressure or heart rate.
Implantable Devices
Consider implanting devices like pacemakers or ICDs for those at high risk of recurrent syncope.
Cognitive Behavioral Therapy (CBT)
Suggest CBT for patients with anxiety-related syncope triggers.
Follow-Up Care
Schedule regular follow-up appointments to track progress and adjust treatment as necessary.
When to see a Doctor?
If you faint unexpectedly, it's important to consult a doctor, especially if it occurs repeatedly, leads to any injuries, or is accompanied by chest pain, shortness of breath, severe headache, blurred vision, or confusion.
Prevention of Fainting
To avoid becoming Syncope loss of consciousness or fainting:
- Avoid situations where your blood sugar is too low.
- Avoid staying in one place for too long without moving, especially if you tend to pass out.
- Get enough fluids, especially in hot weather.
- If you feel like you are about to pass out, lie down or sit with your head tilted forward between your knees.
If you have a health problem, such as diabetes, always wear a medical alert necklace or bracelet.
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