Do you also suddenly faint and fall? (Syncope) - Let's talk about this!

Have you ever seen someone suddenly faint? Or has it happened to you? Imagine a child fainting during a morning assembly at school, or someone suddenly fainting while waiting in line. This is a bit scary. We doctors call this syncope . Simply put, this is fainting, or loss of consciousness. Let's talk about this in more detail today, shall we?

What exactly is Syncope?

Simply put, syncope is a sudden, temporary decrease in the amount of blood flowing to your brain. This is when we faint or lose consciousness. Most of the time, it's caused by something minor and short-lived.

You can:

• If your blood pressure suddenly drops.
• If your heart rate slows down.
• If there are changes in the amount of blood in different parts of your body.

If you faint, you will regain consciousness within seconds or minutes. However, you may feel dizzy and tired for a while afterward. It may take minutes or hours for you to fully recover.

However, this condition called syncope can sometimes be a symptom of a more serious condition. Therefore, if you faint, it is very important to see a doctor to find out the cause and get treatment. Most people can control this condition if they are properly diagnosed and receive appropriate treatment.

Are there different types of syncope?

Yes, there are different types of syncope . Let's see what they are:

• Vasovagal syncope: Also called neurocardiogenic syncope , this is the most common type of syncope. It accounts for about half of all fainting cases.
• Situational syncope: This is also a type of vasovagal syncope, which is described above. That is, it only happens in specific situations.
• Postural or orthostatic syncope: Also called postural hypotension , this is a condition that occurs when you change position (for example, when you suddenly get up from lying down in bed).
• Cardiac syncope: This occurs when blood flow to the brain is reduced due to a problem with the heart or blood vessels.
• Neurologic syncope: This can be caused by a disease of the nervous system.
• Postural Orthostatic Tachycardia Syndrome (POTS): This is a condition where the heart rate suddenly increases significantly upon standing up from a sitting or lying position.
• Syncope with an unknown cause: Sometimes it is difficult to pinpoint the exact cause of fainting.

How common is this?

Syncope is a very common condition. It affects about 3% of men and 3.5% of women during their lifetime. It becomes more common with age, affecting about 6% of people over the age of 75. It can occur at any age, in people with or without other medical conditions.

What symptoms do you feel before fainting?

Often, before fainting, you may experience symptoms like these:

• Feeling like the eyes are turning blue (blacking out).
• Feeling lightheaded, dizzy.
• Being dragged down for no reason.
• Feeling drowsy or groggy.
• Feeling faint, especially after eating or exercising.
• Feeling unsteady or weak when standing or walking.
• Vision changes - such as seeing dots in front of the eyes, or tunnel vision (like looking through a tube).
• Headache.

Important: If you experience these symptoms frequently, be sure to see a doctor.

Why do we feel so faint? (What are the reasons?)

The main cause of fainting is not getting enough blood to the brain. This can have a variety of causes, including the types of syncope we discussed earlier. Many people may have an underlying medical condition that affects their nervous system or heart that they are not aware of. Or, you may have a condition that affects the blood flow in your body, causing your blood pressure to drop when you change positions (for example, when you stand up from a lying position).

Causes of Vasovagal Syncope

This happens because your blood pressure suddenly drops, reducing the amount of blood going to your brain. This often happens after standing for a while, or when you experience a lot of stress, sadness, or fear. Imagine, you're standing in the sun for a long time in the main hall of your school for a morning assembly, and then you suddenly feel dizzy and faint. Normally, when we stand, gravity causes our blood to pool in the lower parts of our body, below the diaphragm . When this happens, our heart and autonomic nervous system work together to keep our blood pressure stable.

However, in this condition called vasovagal syncope , your heart rate and blood pressure suddenly drop too low, which can lead to a decrease in blood flow to the brain, causing fainting. Most of the time, this is not dangerous.

Causes of Situational Syncope

This only happens in certain specific situations where your nervous system is affected and you become unconscious. Some of these situations include:

• Dehydration.
• Intense emotional stress, sadness, anxiety.
• Fear.
• Severe pain.
• Hunger.
• Use of alcohol or drugs.
• Hyperventilation - This means taking in more oxygen and exhaling carbon dioxide more quickly than necessary.
• When coughing loudly, turning the neck, or wearing a collar ( carotid sinus hypersensitivity ).
• When urinating ( micturition syncope ).

Causes of postural syncope

This is also called postural hypotension or orthostatic hypotension . It occurs when you suddenly change position, for example, when you stand up from a lying position, and your blood pressure suddenly drops. Some medications and dehydration can cause this condition. People with this type of fainting experience a drop in their blood pressure of at least 20 mmHg (the top number) and 10 mmHg (the bottom number) when they stand up.

Causes of cardiac syncope

If you have a condition in your heart or blood vessels that affects the flow of blood to your brain, you may experience cardiac syncope . These conditions include:

• Heartbeat abnormalities ( arrhythmia ).
• Impaired blood flow to the heart due to the structure of the heart ( hypertrophic cardiomyopathy ).
• Blockage of blood vessels in the heart ( myocardial ischemia ).
• Heart valve disease.
• Aortic stenosis - This means narrowing of the aorta.
• A blood clot.
• Heart failure.

If you have cardiac syncope , it is very important to see a cardiologist and get proper treatment, as this can be quite serious.

Causes of Neurologic Syncope

This can happen if you have a neurological condition such as a seizure, stroke, or transient ischemic attack (TIA) . Neurologic syncope can also be caused by less common conditions such as migraines and normal pressure hydrocephalus .

Postural Orthostatic Tachycardia Syndrome (POTS)

If you have POTS , your heart rate may increase significantly ( tachycardia ) when you stand up from a sitting or lying position. Your heart rate may increase by 30 beats per minute or more. This increase usually occurs within 10 minutes of standing.

Syncope with no identifiable cause

About 33% of people who faint cannot find the exact cause of their fainting. However, some medications can also increase the risk of fainting as a side effect. If you don't know what's causing your fainting, be sure to see a doctor.

How does a doctor detect this?

If you faint, you should definitely see a doctor. He or she can refer you to a syncope specialist for a full evaluation.

The specialist will examine you physically and take a thorough medical history. He or she will ask you about your symptoms and the times you fainted - whether you had any symptoms before, when and where you fainted.

He or she can also measure your heart rate and blood pressure while you are in different positions (lying down, sitting, standing).

Then, you may need to have one or more tests to find the cause of your fainting. These tests look for things like:

• The state of your heart.
• Your heart rate.
• The amount of blood in your body.
• The way your blood circulates when you are in different positions.

What tests are being done for this?

Tests to find the cause of fainting are:

• Laboratory testing: Check for anemia or metabolic changes .
• Electrocardiogram (EKG): A test that records the electrical activity of your heart.
• Exercise stress test: There are many tests that are done while you exercise or by giving your heart medicine to stress it. Some stress tests look for EKG changes or do an ultrasound of the heart. Stress tests can also be done with nuclear imaging .
• Ambulatory monitor: A device you wear that records information about your heart rate and rhythm through electrodes.
• Echocardiogram: A test that uses sound waves to create an image of the structure of your heart.
• Tilt table test (head-up tilt test): Your blood pressure and heart rate are recorded minute by minute or beat by beat as you lie on a table and the table is tilted at different levels. This test can detect abnormal cardiovascular reactions that can cause fainting.
• Autonomic reflex testing: A series of tests that measure your blood pressure, blood flow, heart rate, skin temperature, and sweating in response to various stimuli. These measurements can help your doctor determine whether your autonomic nervous system is working properly or whether you have nerve damage.

You may also have other tests, such as electrophysiology studies , autonomic nervous system testing , a neurological evaluation, and a CT scan (Computed Tomography - CT scan) . You may also have vestibular function testing to make sure there are no problems with your inner ear. If you need any additional tests, your doctor will explain what they are and why you need them.

What do we do if someone faints?

If someone faints, follow these steps:

1. Check if he is breathing.

2. Have him lie down on the floor, or rest his head between his knees, for at least 10-15 minutes.

3. Give him some cold water to drink.

What are the treatments for fainting?

Treatment options depend on what's causing your fainting and what your test results show. The goal of treatment is to stop you from fainting again.

Treatment options for syncope are:

• Taking medication, or making changes to medications you are already taking.
• Wearing supportive clothing or compression stockings to improve blood circulation.
• Making changes to your diet. Your doctor may tell you to eat small, frequent meals, add a little more salt (sodium) to your diet, drink more water, increase the amount of potassium in your diet, and cut out caffeine and alcohol.
• Being very careful when getting up.
• Keep the head of the bed elevated while sleeping. You can do this by using extra pillows or placing risers under the legs at the head of the bed.
• Avoiding situations or "triggers" that cause fainting (such as standing for long periods of time, heat, and stressful situations).
• Biofeedback training to control a fast heartbeat.
• If there are structural heart diseases, get them treated.
• Installing a pacemaker to keep the heart rate normal (this is only for certain medical conditions).
• Getting an implantable cardioverter defibrillator (ICD) . This device constantly monitors your heart rate and rhythm and corrects any fast, abnormal rhythms (again, only for certain conditions).

Your medical team will develop a treatment plan that is right for you and discuss your treatment options with you.

Are there any medications for this?

Some medications that are used to treat fainting include:

• Midodrine
• Fludrocortisone (brand names Astonin® or Florinef®)

These medications can cause some side effects, such as chest pain, nausea, dizziness, difficulty urinating, stomach upset, and chills. Therefore, it is important to use the medication exactly as your doctor tells you.

Can fainting be reduced/prevented?

To reduce your risk of fainting, you need to know what's causing it. If dehydration is the problem, staying hydrated and drinking plenty of water can help reduce your risk. If you're fainting because of a heart condition, you may need medication or a device to treat abnormal heart rhythms.

Often, you feel like you're about to faint. You may feel dizzy, nauseous, or have palpitations (irregular heartbeats that feel like they're beating too fast or "pounding" in your chest). You can help prevent fainting if you:

• Quickly sit down or lie down and raise your legs.
• Put your hands together.
• Tighten your hands.
• Cross your legs or squeeze your thighs together.

What happens if you faint? Is it something to be afraid of?

With proper diagnosis and treatment, you can control syncope . If you have fainted once, you have about a 30% chance of fainting again. Your risk of fainting again and how it affects you depends on several factors - such as the cause, your age, gender, and other medical conditions you have. If you have questions about your risk, talk to your doctor.

If you have been diagnosed with syncope , check the laws in your country/region. In some countries/regions, drivers who faint must report it to the driver's license office. A doctor will tell you to find out the cause and get treatment before you drive.

Most of the time, fainting is not dangerous. However, if you have an abnormal heart rhythm or a neurological condition, it can be life-threatening. People with heart disease or neurological conditions should definitely seek treatment from a doctor.

When should I see a doctor? Are there times when I need to go to the Emergency Department (ETU) ?

Depending on the cause of your fainting, you will need to see a doctor for a follow-up appointment about two to four weeks after you receive treatment in the hospital or outpatient department. If the doctor finds a problem with your heart's structure or rhythm, you will need to make additional follow-up appointments.

If someone faints and stops breathing, as if they are having a heart attack, you should give them CPR (Cardiopulmonary Resuscitation) and call an ambulance. Many people go to the Emergency Department (ETU) after fainting. If you faint, especially for the first time, or if you have chest pain, difficulty breathing, or other serious symptoms, you should definitely seek medical advice.

Important questions to ask your doctor

You can ask your doctor these questions:

• Do you know what caused me to faint?
• What should I do to prevent the type of fainting I had from happening again?
• Do I need more tests or follow-up appointments?

In summary (Take-Home Message)

Syncope , or fainting, can seem more serious than it really is because it happens suddenly and draws the attention of others. However, for most people, it is a temporary condition and does not indicate a serious health problem. Seeing a doctor after you faint can help you feel reassured that you do not have a serious condition. If your fainting is caused by a heart condition, it is important to get treatment for it.

Remember, if you have any doubts or concerns about your health, it's best to talk to a doctor.

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