Syncope

More commonly known as fainting, blacking out or passing out, syncope (pronounced “sin ko pea”) is a temporary loss of consciousness that happens due to a decrease in blood flow to your brain. With the proper diagnosis and treatment, syncope can be managed and controlled.

Symptoms

Prior to fainting, common symptoms can include:

Feeling dizzy or lightheaded
Cold or clammy skin
Feelings of weakness or unsteadiness
Headache
Nausea
Changes in vision, such as blurry vision, tunnel vision, or seeing spots
Ringing in the ears
Yawning or feeling tired
Blacking out

Types of Syncope

There are several types of syncope, each with a different cause. Sometimes, though, the cause of fainting can’t be determined. Here are some types:

Vasovagal syncope occurs in patients who are under-hydrated and do not have enough fluid on board. While stable most of the time, under certain conditions such as stress, the body attempts to increase blood flow by pumping blood faster and harder. If the patient is not hydrated well enough, heart muscle becomes stiff as it cannot pump blood quickly enough to maintain body requirements. Pressure sensors in the heart muscle like valves on an overheated boiler send a message to the brain that the heart needs a break.

The brain sends a message to the rest of the body to dilate the blood vessels and for the heart to slow down. Sudden decrease in the heart rate and blood pressure that follow cause the fainting to occur.

To prevent this type of faint you need to make sure to stay hydrated. If you are not suffering from congestive heart failure or kidney problems, you should aim to drink 2-3L of water and other beverages without caffeine or alcohol per day. You should make sure to hydrate before and while you exercise. Caffeine and alcohol intake can make this problem worse and should be used in moderation or not at all if you suffer from fainting. You should also aim to maintain salt intake of 2-4g / day.

Certain medications like blood pressure or cold medicines can make this problem worse.

Cardiac syncope:

Cardiac syncope is fainting caused by a problem with your heart. When your heart isn’t working quite as it should, your brain receives less blood.

Several factors can cause cardiac syncope, including:

Structural problems with your heart, such as a tight valve or very poor heart muscle function
Electrical problems with your heart, such as arrhythmias originating in the lower chambers of your heart. These are commonly present in patients with poor heart muscle function, those who have suffered a heart attack and patients with inherited arrhythmia conditions such as hypertrophic cardiomyopathy, Long QT syndrome, the Brugada syndrome, and others
Other conditions, such as a pulmonary embolism or aortic dissection

Common characteristics of cardiac syncope include:

Experiencing chest pain or heart palpitations before fainting
Having fainting symptoms while exercising or exerting yourself
Fainting while you’re lying down

Risk factors for cardiac syncope include:

Age (being older than 60)
Being male
Having heart disease
Having a family history of heart conditions or fainting

Reflex syncope:

Happens when certain reflexes are not properly regulated. This can cause your heart to slow down and a drop in blood pressure. In turn, this can decrease the flow of blood to your brain. Patients with this condition may faint when seeing needles or blood, or when drinking cold fluids, or coughing. In some patients, having a tight collar or simply turning the head may compress an important sensor on the side of the neck which can also trigger a faint.

Orthostatic syncope:

Orthostatic syncope happens due to a drop in blood pressure when you stand up. The drop in blood pressure occurs due to the effects of gravity. Normally, your brain works to stabilize this. But in orthostatic syncope this doesn’t happen. As a result, it can lead to fainting. This can be brought on by certain medications that lower your blood pressure or help control your legs from shaking at night. Patients with diabetes and those with Parkinson’s disease may be more likely to have this problem.

Cerebrovascular syncope:

This type of syncope happens due to a problem with the blood vessels in and around the brain that can prevent the brain from getting enough blood.

Syncope is frequently confused with seizures, and while low blood flow to the brain may also cause seizures – further increasing the confusion, one should always think about the possibility of seizures when treating a patient with syncope.

When to seek medical attention

While not all syncope episodes are serious, you should still contact your doctor if you faint. Seek emergency medical attention if you:

Have heart disease
Have repeated episodes of fainting
Took more than a few minutes to regain consciousness
Are injured from fainting
Are pregnant
Have diabetes
Experienced chest pain or an irregular heartbeat before or after fainting
Lost control of your bowels or bladder before or after fainting

Management and Treatment

Treatment options depend on what is causing your syncope and the results of your testing and evaluation. Options may include:

Taking your time when standing up
Taking medications or making changes to medications you already take
Avoiding shirts with tight collars
Wearing support garments or compression stockings to improve blood circulation.
Making changes to your diet, such as eating small, frequent meals; consuming more salt (sodium); drinking more fluids, increasing the amount of potassium in your diet; and avoiding caffeine and alcohol.
Elevating the head of your bed while sleeping.
If possible, avoid external factors or triggers that may cause you to faint (ie., the sight of blood, stress, etc.)
For certain patients, pacemakers could be implanted to maintain a regular heart rate.
An implantable cardiac defibrillator (ICD). This device constantly monitors your heart rate and rhythm and corrects a fast, abnormal rhythm (only needed for patients with certain medical conditions).

Helping others

If someone faints in your presence, check for injuries and see if they’re still breathing. If they’re uninjured, help position them either onto their back with their legs raised or into a comfortable sitting position. If the person is injured, doesn’t regain consciousness, or isn’t breathing, call 911. Stay with them until help arrives.