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Fainting

Fainting or syncope, known in medical terms, is the loss of consciousness. A person who has fainting spells returns to full consciousness but has no inkling of having lost it in the first place. Usually, it occurs when there is a sudden decrease in the heart rate or blood pressure, hindering the brain’s blood supply. The interruption in oxygen supply to the brain happens because of low blood pressure, the result of which is less availability of blood to the brain as the heart is unable to pump blood. Fainting, followed by the blurring of vision, blackout, light-headedness, feeling of nausea, and dizziness, should not be passed off as just a mere normal occurrence because this may be a warning sign of a serious heart ailment. Dizziness is normal after strenuous work but fainting coupled with these signs is abnormal and warrants certain seriousness if you are ignoring it.[1,2]

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Types

The types of syncopes are classified as per their causes.


  1. Vasovagal syncope or reflex syncope or cardio-neurogenic syncope: Occurs when there is a sudden reduction in blood pressure, reducing blood flow to the brain. Usually, it is benign and is more common in young people. It often happens when the person is standing.

  2. Situational syncope: It is a type of vasovagal syncope that occurs when there is a situation that affects ANS and leads to fainting: anxiety and dehydration.

  3. Postural hypotension/Postural syncope: Occurs when there is a sudden lowering of blood pressure because of a rapid change in the position, e.g. suddenly standing up after lying down.

  4. Cardiac syncope: Occurs because of cardiac conditions such as arrhythmia, heart diseases, and valve diseases. Such conditions affect the blood flow to the brain.

  5. Postural orthostatic tachycardia syndrome (POTS): Occurs when the heart rate of the person is extremely high (an increase of at least 30 beats/min) while standing causing symptoms such as light-headedness and fatigue. It is more common in women than men.

  6. Neurologic syncope: Caused by a neurological issue such as seizure and stroke.

  7. Unknown causes of syncope: This is when the person faints without being aware of any underlying cause. [1,3-5]

Symptoms

The primary symptom of fainting is loss of consciousness and regaining it in a few minutes, thus making a complete recovery.

Other symptoms that might occur before you faint are listed below:


  • Headache

  • Dizziness or light-headedness

  • Nausea

  • Excessive sweating

  • Increased anxiety and panic

  • Collapse

  • Feeling fatigued or weak

  • Tunnel vision

  • Fast heart beats

  • Pale face [1,5,6]

Causes And Risk Factors

Causes


There could be multiple reasons for fainting or passing out:

· Arrhythmia is the important cause of fainting or syncope.

- There are two major conditions associated with arrhythmia – bradycardia and tachycardia. When the heartbeat is extremely fast, it is bradycardia; however, it is known as tachycardia when the situation is the opposite.

- During tachycardia, the heart beats extremely fast giving considerably less time to the heart to fill blood after each heat beat. This blocks the adequate supply of blood to different parts of the body.

- In bradycardia, the heart rate is extremely slow to pump a sufficient amount of blood to the body parts. As in both conditions, the supply to the brain is interrupted, and the outcome is fainting.

- If fainting happens because of irregular heart rhythms — arrhythmia, then it should not be ignored and medical advice must be sought at the earliest. Reasons for a fainting spell can come to the fore only after a proper diagnosis by the doctor; therefore, in any case, a visit to the doctor is required.

· Another reason is orthostatic hypotension.

- Orthostatic hypotension condition causes the pooling of blood in the legs while standing and leads to a sudden reduction in blood pressure, causing the person to faint.

- Medications used for high blood pressure such as prazosin can cause fainting. Blood pressure medications can cause orthostatic hypotension.

  • Neuropathy can cause fainting in individuals. In neuropathy, the functioning of the autonomic nervous system temporarily stops because of conditions such as diabetes or chronic kidney disease.

  • Physical triggers: Physical triggers such as standing up for long, too much heat, suffocation, and rapidly changing positions can cause fainting

  • Hyperventilation: During hyperventilation, the person takes rapid breaths causing CO2 levels to fall. This causes blood vessels to constrict, which reduces blood flow to the brain and causes fainting.

  • Medical conditions such as anaemia, low blood sugar, and POTS may cause fainting.

  • Situational syncope can be attributed to hunger, pain, fear, anxiety, and stress.

  • Coughing, sneezing, and urination can sometimes be a reason for fainting.


Risk Factors


Triggers for fainting:

  • Suddenly standing up or standing up for a long time

  • Emotional turmoil

  • Incessant coughing

  • Non-prescribed medication

  • Loss of body fluid

  • Fear or sudden scare

  • Heart disease

  • Blood loss

  • Extreme heat

Prevention

Precautions to be taken include


  • Do not stand for a long time. Keep moving.

  • If you have been sitting, get up slowly.

  • After a fainting spell, relax for a while.

  • Immediately sit if you have blurred vision.

  • Do not get dehydrated.

  • Avoid crampy spaces if possible.

  • Look for a safer place to sit.


If you feel faint lie down or sit with your head in between the knees, this will help the blood to flow to your brain[7,8].

Diagnosis

Tests that may help identify the underlying condition causing fainting include:


  1. Blood tests to check for anaemia and blood sugar

  2. Stress test: Performed on a treadmill to verify heart rate and blood pressure while performing physical activity

  3. Electrocardiogram: Records electrical activity of the heart

  4. Ambulatory monitor: A monitor that helps record heart rate and rhythm using electrodes

  5. Tilt table test: This test can show abnormal cardiac activity and records blood pressure in real-time by the minute while the table is tilted to different heights. The patient is head up

  6. Echocardiogram: Helps to verify the heart structures using high-frequency waves

  7. Determination of blood volume: To verify if you have blood volume appropriate to your height, weight and sex

  8. Haemodynamic testing: Testing the blood pressure and blood flow inside the blood vessels when the heart is pumping and receiving blood

  9. Reflex testing: Testing of the autonomic reflex system based on several stimuli to verify for nerve damage.


At home, diagnostic Monitors such as Holter monitors and event monitors can be used.[1,4]

Treatment

Visiting a doctor is imminent for any type of fainting as only it will underline the trigger for such spells. If fainting is related to an irregularity in heart rhythms, doctors can gauge it through regular monitoring and suggest a treatment plan, which could involve the implantation of devices such as pacemakers or defibrillators.

Other treatments include:


  • Taking medicines or changing the dose if they are the reason behind the syncope.

  • Use of pacemakers to maintain heart rate.

  • Use of implantable cardioverter defibrillators (ICDs): These are used for people who can develop an abnormal heart rhythm. An ICD is a device that keeps a check on the heart rhythm by giving the heart a shock when the heart starts beating extremely fast.

  • Catheter ablation: This is a procedure in which heart cells cause the abnormal rhythm to be cauterized.[1,4]

Lifestyle/management

Here are a few tips to follow if you are feeling like you are going to faint:


  • Sit down or lie down in a safe place

  • Check for injuries if you have fallen down

  • Do not drive till you are cleared to do so by the doctor

  • Prop your feet up at an angle such that the feet are above the heart. This will help in improving blood flow

  • In case it is not possible to lie down, place your head between your knees to improve the circulation of blood to the brain

  • Turn to one side if you feel nauseous[7,12]


Here are a few things that need to be done when a person has fainted:

  • Check for danger: Ensure the person who has fainted is in a safe place

  • Response: Check if the patient responds to you by asking questions

  • Airway: Check the airway for any type of obstruction. Ensure the airway is clear of obstructions such as vomit and food

  • Breathing: Check if the person is properly breathing. There should be no abnormal breathing.

  • CPR: If the person is not breathing, perform CPR and chest compressions

  • Ambulance: Call for an ambulance.[13]

Prognosis And Complications

Prognosis


Fainting can be controlled and treated. You might get repeated episodes of syncope; therefore, you require to be careful about that, particularly while driving. It is difficult to diagnose the underlying condition because of which you faint. If it is attributed to a heart condition or brain issue, it requires to be treated.[1,6]

Complications


Fainting is serious if:

  • It takes place while doing exercise, driving or during a rigorous activity

  • There is numbness in the body

  • There is shortness of breath

  • There is chest pain

  • It happens for a short span

  • If there is tingling in one part of the body.[12,13]

Alternate Treatments


  • Taking medicines or making changes in the current regime if that is what is causing the syncope

  • Using compression stockings or support garments such that the blood circulation is improved

  • Avoiding situations that trigger feelings such as hunger and pain anxiety such that there is no syncope

  • Being careful when you stand up or change your position

  • Use extra pillows to prop up your head such that while you are sleeping to reduce presyncope

  • Making changes such as eating small meals, keeping yourself hydrated, and eating more salt

  • Avoid caffeine and alcohol

  • Biofeedback training to control a fast heartbeat

  • Treatment of underlying conditions such as structural heart disease.[1,4,6]


References.

  1. Syncope: Symptoms, Causes, Treatments [Internet]. Available at : https://my.clevelandclinic.org/health/diseases/17536-syncope.  (https://my.clevelandclinic.org/health/diseases/17536-syncope)

  2. When should you worry about fainting? - Harvard Health [Internet]. Available at : https://www.health.harvard.edu/diseases-and-conditions/when-should-you-worry-about-fainting#:~:text=The%20condition%20is%20called%20vasovagal,can%20occur%20in%20older%20adults. Accessed on Jun 26, 2021. (https://www.health.harvard.edu/diseases-and-conditions/when-should-you-worry-about-fainting#:~:text=The%20condition%20is%20called%20vasovagal,can%20occur%20in%20older%20adults)

  3. Syncope (Fainting) | American Heart Association [Internet] Available at: https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis--monitoring-of-arrhythmia/syncope-fainting#:~:text=Syncope%20is%20a%20temporary%20loss,enough%20oxygen%20to%20the%20brain. Accessed on Jun 26, 2021 (https://www.heart.org/en/health-topics/arrhythmia/symptoms-diagnosis--monitoring-of-arrhythmia/syncope-fainting#:~:text=Syncope%20is%20a%20temporary%20loss,enough%20oxygen%20to%20the%20brain)

  4. Syncope (Fainting) | Johns Hopkins Medicine [Internet] Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/syncope-fainting#:~:text=Vasovagal%20syncope%20%E2%80%94%20the%20common%20faint,the%20sight%20of%20blood%22.  (https://www.hopkinsmedicine.org/health/conditions-and-diseases/syncope-fainting#:~:text=Vasovagal%20syncope%20%E2%80%94%20the%20common%20faint,the%20sight%20of%20blood%22))

  5. Fainting - Better Health Channel [Internet] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fainting#:~:text=Fainting%20is%20a%20brief%20episode,ensure%20a%20constant%20blood%20pressure. (https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fainting#:~:text=Fainting%20is%20a%20brief%20episode,ensure%20a%20constant%20blood%20pressure)

  6. Fainting - familydoctor.org [Internet] Available at: https://familydoctor.org/condition/fainting/#:~:text=A%20sudden%20drop%20in%20your,health%20conditions%2C%20such%20as%20diabetes. Accessed on Jun 26, 2021 (https://familydoctor.org/condition/fainting/#:~:text=A%20sudden%20drop%20in%20your,health%20conditions%2C%20such%20as%20diabetes)

  7. A Serious Look at Fainting - Health Encyclopedia - University of Rochester Medical Center [Internet] Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=56&contentid=1636&fbclid=IwAR3yl_1XKWf5aty6mA0SodTAjzkyzK9xqT. Accessed on Jun 26, 2021 (https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=56&contentid=1636&fbclid=IwAR3yl_1XKWf5aty6mA0SodTAjzkyzK9xqT)

  8. Fainting (for Teens) - Nemours KidsHealth[Internet] Available at: https://kidshealth.org/en/teens/fainting.html#:~:text=Getting%20too%20hot%20or%20being,cause%20blood%20pressure%20to%20drop. Accessed on Jun 26, 2021. (https://kidshealth.org/en/teens/fainting.html#:~:text=Getting%20too%20hot%20or%20being,cause%20blood%20pressure%20to%20drop)

  9. Autonomic neuropathy or autonomic dysfunction (syncope): information and instructions. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/15631-autonomic-neuropathy-or-autonomic-dysfunction-syncope-information-and-instructions. Accessed on Aug 18, 2021. (https://my.clevelandclinic.org/health/diseases/15631-autonomic-neuropathy-or-autonomic-dysfunction-syncope-information-and-instructions)

  10. Chronic kidney disease. Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-kidney-disease. Accessed on Aug 18, 2021. (https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-kidney-disease)

  11. Arnold R, et al. JRSM Cardiovasc Dis. 2016;5:2048004016677687.

  12. Fainting | Winchester Hospital[Internet] Available at: https://www.winchesterhospital.org/health-library/article?id=11871. (https://www.winchesterhospital.org/health-library/article?id=11871)

  13. Fainting - treatments, symptoms, causes and prevention. Healthdirect [ Available at: https://www.healthdirect.gov.au/fainting. Accessed on Jun 26, 2021. (https://www.healthdirect.gov.au/fainting)

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