What is fainting and what types are there?
Consciousness persists as long as the brain receives enough blood. If the pressure drops sharply or the heart stops pumping blood effectively for a few seconds, a short-term loss of consciousness occurs. Unlike coma or stroke, when someone faints, consciousness returns spontaneously and completely as soon as blood flow is restored, usually after the person is in a horizontal position. Doctors distinguish several groups of syncope. The most common are reflex, the most dangerous are cardiogenic. The scope of the examination, treatment and prognosis depend on which group the episode belongs to.
- Reflex (vasovagal) - against the background of stuffiness, pain, fear, the sight of blood
- Situational - when coughing, urinating, straining, swallowing
- Orthostatic - with sudden standing up, dehydration, taking blood pressure medications
- Cardiogenic - for arrhythmias, blockades, aortic valve stenosis, cardiomyopathies
- Carotid sinus syndrome - when turning the head or a tight collar in the elderly
Causes and risk factors
In young people, fainting is almost always a reflex: in response to a provoking factor, the pulse slows down and the blood vessels dilate. In the elderly, orthostatic and cardiogenic causes, as well as side effects of medications, are more common. Fainting may be the first manifestation of hidden heart disease, so the doctor is wary of episodes without warning, during exercise or in a lying position. Conditions similar to fainting - epileptic seizure, hypoglycemia, panic attacks, transient ischemic attack - have different mechanisms and are treated differently. Sometimes there are several reasons: for example, dehydration in the heat in a person taking diuretics.
- Standing for a long time in stuffy conditions, heat, dehydration
- Hunger, lack of sleep, alcohol
- Blood pressure medications, diuretics, some antidepressants
- Anemia and blood loss
- Diabetes mellitus and Parkinson's disease with damage to the autonomic nerves
- Heart rhythm and conduction disorders, valve defects
How does fainting manifest itself and how to help?
Reflex fainting is usually preceded by precursors: lightheadedness, nausea, darkening or “floaters” in the eyes, ringing in the ears, cold sweat, yawning. If you lie down or sit up in time, the episode can often be prevented. During fainting, the person is pale, the pulse is weak, there may be isolated muscle twitches, which do not mean epilepsy. First aid: lay on your back, elevate your legs, loosen the collar and belt, ensure a flow of fresh air. There is no need to lift a person and give him something to drink until he has fully come to his senses. After fainting, it is better to lie down for a few more minutes and get up slowly.
- Lay on your back and elevate your legs
- Unbutton tight clothes, open the window
- If vomiting, turn person on side
- Do not give water or tablets to an unconscious person
- Get up slowly, from a sitting position
- If consciousness does not return within 1–2 minutes, call 103
Diagnostics
The basis of the examination is a detailed story from the patient and witnesses: what preceded the attack, how long the loss of consciousness lasted, whether there were convulsions and how quickly the person came to his senses. The doctor measures the pressure while lying and standing, listens to the heart and prescribes an ECG. If there is a suspicion of arrhythmia, 24-hour ECG monitoring is performed, and if there is a heart murmur, echocardiography is performed. For repeated unexplained episodes, a tilt test or long-term rhythm recording is used. EEG and MRI of the brain are needed only for signs of epilepsy or neurological symptoms.
- ECG at rest
- Pressure measurement while lying and standing (orthostatic test)
- Holter ECG monitoring
- Echocardiography
- Complete blood count, glucose, electrolytes
- Tilt test and stress tests - according to indications
- EEG - if an epileptic seizure is suspected
Treatment and prevention
For reflex syncope, the main treatment is understanding the mechanism and recognizing warning signs. The doctor explains how to avoid provoking situations and what to do at the first sign of lightheadedness. A sufficient drinking regime and physical countermeasures help: cross your legs and tense your muscles, clench your fists. Medicines for reflex fainting are rarely needed and are selected individually. If drugs are the cause, the doctor reviews the treatment regimen. Cardiogenic syncope requires treatment for heart disease, sometimes a pacemaker. People with repeated fainting should talk to their doctor about driving and working at heights.
- Drink enough fluids, especially in hot weather
- Do not stand still for a long time, shift from foot to foot
- If you feel faint, sit or lie down immediately
- Countermeasures: cross your legs, tense your thighs and buttocks, clasp your hands and spread them apart
- Do not stop taking blood pressure medications on your own - only after consultation.
- Treat arrhythmia or heart disease if detected