Fainting (Syncope)

• Dizziness
• Lightheadedness
• Nausea
• Visual disturbances
• Cold clammy skin
• Sweating
• Weakness
• Decreased heart rate
• Low blood pressure
• Headache
• Yawning
• Blackouts

The brain requires blood flow to provide oxygen and glucose to its cells to sustain life. Fainting is caused by a decrease in blood flow to the brain due to the following reasons or a combination of them:

• The heart fails to pump the blood.
• The blood vessels lack enough tone to maintain adequate blood pressure to deliver blood to the brain.
• There is not enough blood or fluid in the blood vessels.

Some of the most common types of syncope and their causes are discussed below:

1. Vasovagal syncope

It is the most common type of syncope caused by a sudden drop in blood pressure, which leads to decreased blood flow to the brain. The most common triggers for vasovagal syncope include:

• Prolonged standing
• Fear of injury
• Physical or psychological stress
• Dehydration
• Bleeding
• Pain
• Strain
• Heat exposure
• Sight of blood

When an individual stands, gravity causes blood to settle in the lower part of the body, leading to syncope. In some cases of physical trauma, the body lowers blood pressure and heart rate to reduce the amount of bleeding, which causes syncope.

2. Situational syncope

Situational syncope occurs when a specific situation acts as the trigger for a syncopal episode, such as:

• Urination
• Defecation
• Forceful coughing
• Sneezing
• Swallowing
• Post-exercise
• Dehydration
• Intense emotional stress
• Anxiety
• Fear
• Pain
• Hunger
• Use of alcohol or drugs
• Breathing in too much oxygen and getting rid of too much carbon dioxide too quickly.

3. Cardiogenic syncope

Various heart conditions can cause fainting. These include:

• Heart beating too fast or too slow
• Abnormalities of the heart valves
• Widespread disease of the heart muscle
• Blockage of blood flow from the heart

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4. Orthostatic hypotension syncope

It is a transient loss of consciousness due to reduced blood flow to the brain caused by:

• Volume depletion: Inadequate fluid intake (hot weather), diarrhea, vomiting, etc.
• Drug-induced orthostatic hypotension: Alcohol, vasodilators, diuretics, and beta-adrenergic blockers
• Diseases of the nervous system: These include Parkinson’s disease, Lewy body dementia, diabetes, amyloidosis, and spinal cord injuries.

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5. Neurologic syncope

It is caused by neurological conditions such as:

• Seizure
• Stroke
• Migraine
• Abnormal build-up of cerebrospinal fluid (CSF) in the brain.

6. Postural orthostatic tachycardia syndrome (POTS)

This condition is characterized by a very fast heart rate (tachycardia) that occurs when a person stands after sitting or lying down. Normally, when a person stands, the nerves send signals to the blood vessels in the lower body to tighten. The tightening vessels work against gravity to prevent blood from collecting in the legs. If there is insufficient blood flow to the brain, a person may feel lightheaded or faint every time they stand. This condition is most common in women, but it can occur in men as well.

7. Other causes

The lesser common causes of syncope include:

• Hypoglycemia (low blood sugar)
• Hypoxia (decreased oxygen)
• Symptomatic anemia
• Tumor in the heart
• Panic attacks

Fainting (Syncope) is common in older adults, but younger individuals without cardiac disease may experience syncope while standing or have specific stress or situational triggers. Risk factors include:

• Age > 65 years
• Male gender
• Structural heart disease
• Heart failure
• Family history of fainting or cardiac conditions
• Syncope-related trauma
• Hypertension
• Palpitations
• Abnormal ECG
• High levels of troponin in the blood (an indicator of recent heart attack)

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Fainting (Syncope) may not be life-threatening, but repeated syncopal episodes can be a cause of worry. Diagnosing the actual cause of syncope is very important to prevent further episodes. The syncope diagnosis includes:

A. Medical history
A thorough history can provide valuable information in determining the etiology of a syncopal episode. Information about current medications and pre-existing medical conditions such as diabetes, heart disease, or psychiatric illness can help pinpoint the cause of syncope.

B. Physical examination
Physical exams should focus on examining the vital signs of the patient through neurologic and cardiac examinations. The doctor will measure your heart rate and blood pressure to help determine if a rhythm disturbance or low blood pressure caused the syncope. You may be asked to sit or stand while the blood pressure is measured to test for orthostatic hypotension.

C. Investigations
Tests to effectively diagnose syncope include:

• Electrocardiogram (ECG): A widely available and inexpensive method that records the electrical signal from the heart and provides information about potential and specific causes of syncope, such as abnormal heart rhythms and other cardiac problems.
• Echocardiogram: This test uses ultrasound imaging to view the heart and is used in patients with unexplained syncope and a positive cardiac history or abnormal ECG.
• Treadmill test (TMT): Also known as an exercise stress test, this study examines heart rhythms during exercise, usually conducted while you walk or jog on a treadmill.
• Blood tests: Routine blood tests, such as complete blood count (CBC), check for anemia, which can cause or contribute to fainting spells.
• Tilt table test: Performed when there are no heart problems associated with syncope. The patient lies flat on a table that changes positions, tilting upward at various angles while a technician monitors heart rhythms and blood pressure to see if changing posture affects them.
• Blood volume determination: This test assesses if the individual has the appropriate amount of blood in the body based on gender, height, and weight. Measuring blood volume may explain the mechanisms of syncope in individuals with unknown causes.
• Rhythm monitoring: May be recommended to diagnose rhythm problems that come and go and have not been detected with a routine ECG. These include:
• Holter monitor: A device that monitors heart rhythm during normal daily activities at home for 24 or 48 hours.
• Event recorder: Captures rhythm problems associated with a syncopal episode.
• Implantable loop recorder: Monitors rhythms over an extended period of time, typically 18 to 24 months.
• Electrophysiology study: Performed if you have heart disease or rhythm problems, assessing susceptibility to abnormal rhythms under controlled conditions.
• Electroencephalogram: Measures electrical activity in the brain. Used to diagnose seizures but may also be part of the evaluation of unexplained "collapse" events.
• Hemodynamic testing: Checks blood flow and pressure inside the blood vessels when the heart muscle contracts and pumps blood throughout the body.
• Autonomic reflex testing: A series of tests that monitor blood pressure, blood flow, heart rate, skin temperature, and sweating in response to certain stimuli to check for nerve damage causing syncope.

Recurrent syncope affects quality of life, and the degree of impairment is proportional to syncope frequency. Some strategies to prevent future syncopal episodes include:

• Eat right: Consume regular meals and avoid skipping them, as low blood sugar levels can lead to syncope. Increase your salt intake to expand blood volume by retaining fluids, which helps prevent drops in blood pressure.
• Know your triggers: Understand what causes syncope for you and avoid these triggers. Consult your doctor to identify the causes of your episodes and ensure you take all medications on time as prescribed.
• Manage presyncope symptoms: Lie down when you notice the onset of syncope symptoms and avoid excessive exertion. If you must stand for prolonged periods, keep your legs moving. Simple exercises like leg crossing, squatting, and tensing your legs and buttocks can help raise blood pressure.
• Use compression stockings: Compression stockings apply pressure to the legs, reducing the diameter of veins and increasing blood flow in the legs.
• Stay hydrated: Dehydration is a significant yet often overlooked cause of syncope. Drink at least 2 liters of water daily to maintain proper hydration.
• Avoid long and hot showers: Heat can cause blood to shift to superficial tissues, and hot water dilates blood vessels, leading to a drop in blood pressure.
• Cope with your anxiety: If you experience anxiety, find ways to calm yourself to prevent syncope. Techniques such as meditation, yoga, or exercise can be effective.
• Stop smoking: Tobacco use can constrict blood vessels, and smoking while standing may trigger orthostatic syncope. Consider using smoking cessation resources if you are looking to quit this harmful habit.

Treatment of the underlying cause is the focus in managing fainting. During an acute episode, patients should be made to sit or lie down quickly, and raising the legs can aid recovery. Any injuries sustained during a sudden fall from syncope should receive immediate attention. Treatment options, depending on the types of syncope, include:

1. Vasovagal Syncope

Conservative measures include:

• Avoiding situations or stimuli that have caused syncope
• Increasing the intake of salt and fluids
• Making lifestyle modifications

Other modalities include:

• Drug therapy: Many agents have been prescribed for vasovagal syncope that might be useful if conservative measures fail, including:
• Beta-blockers
• Selective serotonin reuptake inhibitors
• Hydrofludrocortisone
• Proamatine
• Fludrocortisone
• Alpha agonists
• Tilt Training: This consists of long periods of upright posture and has been recommended for patients with significant symptoms of syncope. Long-term benefits have yet to be demonstrated, with issues related to compliance.
• Device Therapy: Based on limited yet compelling randomized controlled trial data, permanent pacing is indicated in carotid sinus syndrome, which clinically manifests as syncope.

2. Orthostatic Hypotension

The treatment for this type of syncope is generally conservative and consists of:

• Rising slowly from sleeping and sitting positions
• Avoiding medications like diuretics and vasodilators
• Using compression stockings to improve blood circulation
• Administering intravenous fluids in dehydrated patients
• Using protamine in unmanageable cases

3. Cardiac Syncope

Treating underlying conditions is the goal for this type of syncope. Patients with syncope and underlying heart disease need regular follow-ups with their physician and cardiologist. The goals of treatment are to reduce mortality, injury, and recurrences. Treatment is best directed at correcting the underlying cause when possible. Surgery to incorporate a pacemaker may be required in conditions like slow or rapid heartbeats. A healthy heart is key to a healthy body. Learn tips and tricks to maintain heart health.

Fainting (Syncope) may be caused by a serious underlying health condition, so always check with your doctor before taking any herbs or supplements. Some of the home remedies that can help you with recurrent episodes of syncope include:

A. Nutrition and supplements

• Omega-3 fatty acids: Such as fish oil may help reduce inflammation and improve heart health. Cold-water fish, such as salmon or halibut, are also good sources.
• Alpha-lipoic acid: This antioxidant may be beneficial for heart health. People who take thyroid hormone should consult their doctors before taking alpha-lipoic acid.
• L-arginine: An antioxidant that may help promote good circulation. Individuals with a history of heart attack, heart disease, low blood pressure, or circulatory issues should speak to their doctors before taking L-arginine.
• Whole grains: Incorporate high-fiber foods such as beans and whole grains. Lean protein sources like fish and chicken are also good choices, as they take longer to digest and do not cause a sudden drop in blood pressure.

B. Herbs

Herbs have been used to strengthen the body and treat diseases. However, they can trigger side effects and interact with other herbs, supplements, or medications. Always talk to your doctor before starting anything new. Some herbs that can prove to be very beneficial include:

• Green tea: Rich in antioxidants and anti-inflammatory substances that may be good for heart health.
• Blueberry: An antioxidant that helps promote good circulation. May increase the risk of bleeding, especially if you also take blood thinners.
• Apple cider vinegar: One common cause of dizziness is low blood sugar, and apple cider vinegar might help with that, according to a study in diabetes care.
• Ginger (Adrak): Offers surprising benefits, including reducing nausea, which can be a precursor to syncopal episodes.

Fainting (Syncope) is not a sign of a fatal disease, particularly if it only happens once. Complications of syncope include:

• Injuries from falls
• Fractures from fainting

The elderly have a higher risk of injury compared to younger individuals who experience syncope.

Always remember to get approval from your doctor before starting any complementary or alternative therapy, as some therapies may be contraindicated with ongoing treatment. Alternative therapies that can prove beneficial in managing or preventing syncope include:

• Homeopathy: Syncope has been treated by homeopathy, which requires detailed specific prescribing of the "right" homeopathic remedy. An experienced and certified homeopath will assess your individual constitution and symptoms, and then recommend remedies.
• Acupuncture: Acupuncture may help treat syncope. Studies have shown that acupuncture uses techniques to regulate yin and yang, promoting the reproduction of body fluids and restoring circulation. While acupuncture does not often cause side effects or complications, some individuals may faint during treatments; however, this is not considered a serious complication.
• Massage therapy: You can activate your body’s acupressure points to relax and self-treat. Receiving a massage is a more enjoyable and relaxing activity that promotes a sense of calm and can help alleviate dizziness. A soothing massage with lavender essential oil may be beneficial if you are prone to anxiety.