Falling into a |dead faint

Fainting or swooning was so common in Victorian England that the houses of the upper classes even had a fainting room where ailing ladies – never men – could lie down on a special couch and be treated with smelling salts until they recovered. While one theory has it that either overly tight corsets or hysteria were to blame, the fact is that even in today’s corsetless society, women – and yes, men too – can and occasionally do pass out.

Sometimes referred to as a malaise or syncope, this loss of consciousness is often a benign condition that might not need medical attention. In some cases however, it might reveal a serious underlying medical issue and requires prompt investigation. 

Syncope can occur at any age and current estimates indicate that about 50 per cent of individuals will experience fainting at one time in their life. 

Passing out can be the result of three main groups of acute conditions: the most frequent syncope – the terminology commonly used by doctors – typically lasts few seconds to two minutes during which the individual totally loses consciousness. A milder form of syncope that leads to a partial loss of consciousness is referred to as lipothymia but carries the same potential risk as syncope. People with syncope usually fully recover within a few minutes. 

The second condition is epilepsy and is due to an abnormal disordered activity of numerous brain cells occurring simultaneously and leading to seizure. There are several types of epilepsy ranging from the typical generalised seizures causing sudden and total unconsciousness, stiffening and shaking of many parts of the body, loss of urine and the biting of the tongue to the partial (or focal) seizures with limited involuntary movements, dizziness and without loss of consciousness. The dramatic signs of epileptic seizures often last several minutes but the patient continues to suffer from a post-critical confusion that persists for more than 30 minutes. 

Third are the non-epileptic events that mimic epilepsy manifestations but without complete loss of consciousness. Lasting up to several hours, these non-epileptic crises often originate in psychological causes. 

For the purpose of this article, only syncope is discussed.

Syncope is due to an acute and transient reduction in blood supply to the brain that leads to sudden impairment in cerebral function. The initial symptoms include lightheadedness, blurred vision, skin paleness, cold sweat and finally sudden loss of consciousness. The main cause is the vasovagal syncope, which is induced by an abnormal reactivity of the two nervous systems regulating blood pressure and heart rate. In response to an emotionally charged trigger such as confinement in warm space, the sight of blood or the sight of someone choking, the slow down in heartbeat coupled with the lowering of blood pressure leads to a reduced blood supply to the brain triggering the syncope. Compensatory mechanisms (such as release of nor-adrenaline) are immediately activated to restore a normal heart and subsequently brain function. Other causes of syncope include cardiac causes (especially heart rhythm disorders that can be life-threatening) and orthostatic hypotension that results from an insufficient blood pressure level when standing up.

Commonly found in the elderly, orthostatic hypotension is often due to medications (antihypertensive agents, antidepressants) or due to certain conditions such as anemia, dehydration, diabetes and Parkinson’s disease.

Low blood sugar (hypoglycemia) is also responsible for acute malaise suggestive of syncope. 

The diagnosis of syncope or other unconsciousness syndromes is often straightforward and relies primarily on the thorough questioning of the person and/or those who witnessed the attack. 

The treatment of syncope depends on its cause: vasovagal syncope typically does not need any treatment. The person needs to be able to recognize the premonitory signs to avoid full-blown syncope and a related injury in case of fall. 

Due to its potential serious complications, syncope from cardiac origin should promptly be managed by a cardiologist. Orthostatic hypotension imposes, when appropriate, the discontinuation of the responsible medicines and optimal treatment of the predisposing medical condition. The patient should also be informed on how to prevent such an event, for instance moving progressively, step by step before standing up. 

If you feel that you are going to faint, lie down immediately and raise your legs. This will help the blood to flow to the head bringing higher blood supply to your brain. If you can’t lie down, sit with your head bent forward between your knees. To avoid a possible relapse, it is wise to remain on the ground for 5 to 10 minutes before standing up again. In the absence of any obvious trigger, seeking a medical opinion is advisable. 

 

DR GERARD LALANDE is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].