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Faint of heart

Why you need to know about syncope


By Dr. Kaycee Reyes


We have all seen it in movies: the leading lady faints at the sight of her beloved, or a worried mother loses consciousness at the sad news about her son, or the protagonist passes out at the sight of a ghost.

While there is a rare chance that any of these may happen in life, syncope, or a temporary loss of consciousness is real and it happens to more people than we ever know. Passing out or briefly losing consciousness, however, has a lot of causes, which may come from non-life threatening ones such as exhaustion, to more serious health problems such as a heart condition. Other times, passing out may mimic syncope but may have other underlying health issues such as seizures, brain injury, or sleeping problems that are a challenge among physicians to identify. And even if most of us are not doctors, reading about syncope may raise awareness and encourage more people to watch over their health.

Syncope literally happens to the “faint of heart,” because one of the most serious causes of syncope is an underlying heart condition. But confirming that it is coming from a cardiac source is the easy part; determining the factors per individual who has syncope is the hard one. Syncope is caused by a fast drop in blood pressure, or when there is not enough blood flow passing through the brain. This happens when the person’s blood pressure is too low and the heart does not pump enough oxygen to the brain that results in a person fainting. And when one loses consciousness, the body loses control as well, leading to falling, collapsing, or other accidents, especially when one is upright or moving.

There are different types of syncope:

  • vasovagal syncope (as described above);
  • situational syncope, a type of vasovagal syncope but only occurs in some situations that affect the nervous system, like too much stress, anxiety, pain, hunger, hyperventilation, too much drugs or alcohol, and more;
  • postural syncope, that happens with a sudden shift in bodily movement that immediately drops their blood pressure, causing them to faint, such as lying down to standing up (orthostatic syncope);
  • cardiac syncope, that happens when one has a heart condition that affects the blood flow to the brain, such as arrhythmia (abnormal heartbeat), structural heart disease (issues in how the heart is formed), blood clot, and more;
  • other causes that may be brought about medications or other rare causes

 As mentioned in the introduction, there are some health conditions that may mimic syncope but are not—these may be seizures, sleeping problems, other neurological issues, and more. With the wide range of possible causes of both true syncope and non-syncope, the physician then has to perform a thorough medical checkup, including studying the patient’s medical history (pre-acquired illnesses such as heart problems, neurological disorders, diabetes, and lifestyle such as smoking or drinking), medications taken, family history of syncope (if there is), and a full physical examination on the patient. For example, having multiple incidences of syncope in a short period of time is different from having multiple episodes in a day (which only mimics syncope, but is apparently not). At the same time, physicians have to know the symptoms prior to syncope, what the patient was doing or his/her position on the onset of syncope, how long it lasted, what the symptoms were after the episode, and the frequency of the incidence. Furthermore, the witness may also be asked by the physician for other clues pointing to the actual cause, which could not be answered by the patient, such as what the patient looked like before the episode (pale, etc.), how long the syncope lasted, how the patient fell or collapsed, any notable physical movements before or after the episode (tongue biting, etc.), and so on. Full physical examination on the patient includes taking the vital signs and monitoring closely for any changes. Afterward, the physician also has to determine if the patient needs extra care and should stay in the hospital (high risk), the patient may or may not need to be admitted, depending on the case (intermediate risk), or may be treated as an outpatient (low-risk). About half the time, diagnosis is predicted correctly with vasovagal syncope, postural syncope, and cardiac syncope. About 30 percent of cases are suspected, and 20 percent of cases are unknown, which means further testing and evaluation is needed (ECG, EEG, MRI, etc. as needed).

If you or someone you know has passed out in any instance, do not panic. Do not, however, overlook it as something minor, either. Knowing that syncope can be caused by a lot of factors, it is always best to check with your doctor and have a thorough medical exam to rule out any possible life-threatening causes. Even if you have not experienced syncope, continue being mindful of your overall health and have regular checkups as well. It is easy to avoid visiting the doctor once in a while, but remember that it is better to know it early and take steps to prevent it than catching a disease too late.

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