Syncope (Fainting): Types, Causes, and Treatment Options

Symptoms of Syncope

Here are the common symptoms of Syncope (fainting):

• Lightheadedness or dizziness
• Sudden weakness
• Blurred or tunnel vision
• Nausea
• Cold, clammy skin
• Sweating
• Ringing in the ears
• Feeling warm or hot
• Paleness
• Brief loss of consciousness
• Confusion after waking up

Usually, these symptoms happen just before a person faints.

Types of Syncope

The type of problem you experience depends on the cause.

Vasovagal Syncope (cardio-neurogenic Syncope)

• Vasovagal Syncope is the most common type of Syncope. It is caused by a sudden drop in blood pressure, which results in decreased blood flow to the brain.
• When you stand up, gravity causes blood to pool in the lower part of your body, underneath your diaphragm.
• When this happens, the heart and autonomic nervous system (ANS) work to keep your blood pressure stable.

Situational Syncope

This only happens in certain situations that affect the nervous system and lead to Syncope. Some of these situations are:

• Dehydration
• Intense emotional stress
• Anxiety
• To fear
• Pain
• Hunger
• Alcohol or drug use
• Hyperventilation (breathing too much oxygen and getting rid of too much carbon dioxide too quickly)
• Coughing forcefully, turning your neck, or wearing a tight collar (carotid sinus hypersensitivity)
• Urinating (attenuating syncope)

Postural Syncope (Postural Hypotension)

• Postural Syncope is caused by a sudden drop in blood pressure due to a rapid change in position, such as from lying down to standing. Certain drugs and dehydration can lead to this condition.
• It usually causes a drop in blood pressure of at least 20 mmHg (systolic, or upper number) and at least 10 mmHg (diastolic, or lower number) when standing.
• Cardiac Syncope is caused by a heart or vascular condition that affects blood flow to the brain.
• These conditions can include an abnormal heart rhythm (arrhythmia), blocked blood flow to the heart due to structural heart disease (how the heart is formed), blockage of the heart's blood vessels (myocardial ischemia), aortic stenosis, blood clots, or heart failure.

Neurological Syncope

• Neurological Syncope is caused by a neurological condition such as a seizure, stroke, or transient ischemic attack (TIA).
• Migraine headaches and normal pressure hydrocephalus are other less common conditions that lead to it.

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural-orthostatic tachycardia syndrome is caused by a very rapid heart rate (tachycardia) that occurs when a person stands after sitting or lying down.

The heart rate can accelerate by 30 beats per minute or more. The increase normally occurs within 10 minutes of standing. The condition is most common in women, but it can also occur in men.

Causes of Syncope Symptom

Cardiac Syncope is caused by a heart or vascular condition that affects blood flow to the brain.

These conditions can include;

• Abnormal heart rhythm (arrhythmia)
• Structural heart disease (the way the heart is formed)
• Blockage of the heart's blood vessels (myocardial ischemia)
• Valve disease
• Aortic stenosis
• Blood clot
• Heart failure

What Are The Causes of a Syncopal Attack

Syncope is a symptom that can be caused by several conditions, ranging from mild to life-threatening ones. Many factors, such as overheating, dehydration, profuse sweating, exhaustion, or the pooling of blood in the legs due to sudden changes in body position, can trigger Syncope.

It is important to determine the cause of the Syncope and the underlying conditions.

When to See a Doctor?

If you faint unexpectedly, it's important to consult a doctor, especially if it occurs repeatedly, leads to any injuries, or is accompanied by chest pain, shortness of breath, severe headache, blurred vision, or confusion.

Diagnosis of Fainting

To diagnose the cause of your fainting, your physician will first take your medical history. They will ask you about your symptoms, what you were doing when you passed out, and if you are taking any medications or have any underlying conditions.

Various tests can be used to diagnose the cause of fainting. These tests may include:

• Electrocardiogram (ECG): An ECG measures the rhythm and electrical activity of your heart using small electrodes. In some cases, you may need to wear a portable ECG machine to monitor your heart's activity over a period of time.
• Lab tests: Blood tests can help identify conditions such as diabetes, anemia, or cardiac markers.
• Tilt table test: During a tilt table test, you will be strapped to a special table. Your heart rate and blood pressure are measured as you go from lying down to standing upright.
• Carotid sinus massage: Your doctor will gently massage your carotid artery, located in your neck. They will check to see if symptoms of fainting occur.
• Stress test: A stress test measures how your heart responds to exercise. Your heart's electrical activity will be monitored by an ECG as you exercise.
• Echocardiogram: An echocardiogram uses sound waves to create a detailed picture of your heart.
• Electrophysiology: With electrophysiology, small electrodes are threaded through a vein and into your heart to measure the electrical impulses in your heart.
• Imaging tests: These tests may include a CT scan or MRI, which captures images inside your body. These tests are most often used to examine the blood vessels in your brain when a neurological cause of fainting is suspected.

Treatment and Management for Syncope

If someone experiences Syncope:

• Help them lie flat with their legs elevated to improve blood flow to the brain.
• Loosen tight clothing.
• Ensure a safe environment to prevent injuries during a fall.
• Seek medical help if the fainting is unexplained, recurrent, or associated with chest pain, shortness of breath, or injury.

Treatment Based on Cause

• Vasovagal Syncope (triggered by stress, pain, or standing too long): Often managed with lifestyle changes like increasing fluid and salt intake, learning physical counter-pressure maneuvers, and avoiding known triggers.
• Cardiac Syncope (due to heart problems like arrhythmias): May require medications, pacemaker implantation, or other cardiac procedures.
• Orthostatic Hypotension (sudden drop in blood pressure upon standing): Managed with slow positional changes, compression stockings, medication adjustments, and hydration.
• Neurological Syncope: Treatment targets the underlying neurological condition, like epilepsy or stroke, if diagnosed.

Prevention of Fainting

To avoid becoming Syncope, loss of consciousness, or fainting:

• Avoid situations where your blood sugar is too low.
• Avoid staying in one place for too long without moving, especially if you tend to pass out.
• Get enough fluids, especially in hot weather.
• If you feel like you are about to pass out, lie down or sit with your head tilted forward between your knees.

If you have a health problem, such as diabetes, always wear a medical alert necklace or bracelet.

Home Remedies for Syncope

• Stay Hydrated: Drink plenty of water daily to maintain blood pressure and circulation.
• Salt Intake (If Advised): Some people with low blood pressure may benefit from slightly increased salt intake (consult your doctor).
• Eat Small, Frequent Meals: Prevent blood pressure drops by avoiding large, heavy meals.
• Compression Socks: Wearing compression socks can help improve blood flow and reduce the risk of dizziness or fainting.
• Lie Down or Sit Immediately: At the first sign of dizziness or weakness, lie down or sit with your head between your knees.
• Avoid Sudden Position Changes: Stand up slowly from sitting or lying positions to prevent dizziness.

Lifestyle Changes for Syncope

• Identify and Avoid Triggers: Know what causes your episodes (heat, stress, dehydration) and try to avoid them.
• Manage Stress: Practice relaxation techniques like deep breathing, meditation, or yoga to keep stress under control.
• Regular Exercise: Gentle activities like walking or swimming can improve heart health and circulation.
• Monitor your medications: Review them with a doctor; some may contribute to fainting spells.
• Avoid Alcohol: Alcohol can lower blood pressure and trigger fainting episodes.
• Healthy Diet: Maintain a balanced diet rich in nutrients to support cardiovascular health.
• Medical Follow-up: Regular check-ups to monitor heart and blood pressure health are essential if you have frequent syncope episodes.