FAINTING OR SYNCOPE: ALL YOU NEED TO KNOW

Medically Reviewed by Dr. Rae Osborn, Ph.D. - July 25, 2024

Fainting is a temporary loss of consciousness or sudden passing out caused by an abrupt drop in blood flow to the brain. The medical term for fainting is syncope. 

Syncope is responsible for roughly 1-1.5% of all visits to an emergency ward ^[1]. It can happen to anyone, regardless of age or gender, but it is more common in children and older adults. Knowing what to do when someone faints is essential because, in rare yet serious cases with a cardiac cause, there is a risk of mortality. 

This article will discuss everything you need to know about syncope, including its causes and symptoms, how to prevent it, and what to do when someone faints.

Warning Signs (Presyncope)

The phase leading up to fainting is known as presyncope.

Before fainting, a person may experience the following:

• Feeling lightheaded or dizzy
• Nausea
• Blurred vision, often described as visual "gray out"
• Sudden sweating
• Feeling hot or cold
• Ringing in the ears
• Pale skin
• Rapid breathing
• Heart palpitations or irregular heart rhythm
• Weakness or fatigue

If you experience any of these symptoms, try to sit or lie down immediately to reduce the risk of syncope.

How Long Does Fainting Last?

An episode typically lasts for a few seconds or up to a few minutes. However, it may take a while for the person to recover fully and return to normal. In some cases, a person may experience a fainting spell that lasts longer than a few minutes. A prolonged fainting episode may require medical attention.

What Happens to Your Body When You Faint?

Syncope occurs (in some cases) when the blood vessels in your body dilate or widen, causing blood to pool away from your brain.

There is a sudden drop in blood flow to your brain, which abruptly receives less oxygen and nutrients, leading to a brief period of unconsciousness. A new study in mice recently revealed a small subset of neurons that may be responsible for triggering syncope in the brain. Researchers found the neurons in the periventricular zone of the brains of these mice. A lack of activity in this brain region prolonged consciousness loss. More research may uncover additional syncope triggers.

What Causes Fainting?

The most common cause of fainting is vasovagal syncope, known as the 'common faint.' This type comprises 50% of all episodes.^[2]

Several factors can trigger syncope, such as^[3]:

• Physical triggers: Standing up too quickly, dehydration, prolonged standing, extreme heat or cold, and severe pain^[4].
• Emotional stress: Strong emotions, such as fear, anxiety, or pain.
• Hyperventilation: Rapid, shallow breathing can cause a drop in blood pressure and lead to fainting.
• Medical conditions: Certain conditions that affect blood flow can increase the risk of syncope. Examples include anemia, low blood sugar, and heart disease, such as carotid artery disease.
• Pregnancy: Hormonal changes and blood volume fluctuations during pregnancy can make fainting more likely.

Can you faint from a panic attack?

Yes, it is possible to faint from a panic attack. Panic attacks can cause several symptoms, including rapid heart rate, sweating, and dizziness. These symptoms can trigger a drop in blood pressure, leading to syncope.

Do Women or Men Faint More and Why?

Syncope is more common in women than men^[5], especially young women. Reasons include hormonal changes, blood vessel constriction, and the tendency to hyperventilate.

Conditions That Mimic Syncope 

Other conditions can also lead to loss of consciousness, but they are not considered syncope. These include:

• Seizures
• Heart attacks
• Head injuries
• Strokes
• Postural Orthostatic Tachycardia Syndrome (POTS)
• Intoxication
• Brain injuries
• Diabetic hypoglycemia (ketoacidosis or metabolic coma)
• Hypoxia (low oxygen)
• Severe allergic reactions
• Other emergencies

Types of Fainting

Episodes can be classified into many types based on their underlying cause^[6]:

• Cardiac Syncope (Serious Cardiovascular Conditions): Syncope caused by heart problems like irregular heartbeat or low blood pressure.
• Reflex Syncope: The most common type of fainting caused by reflexes that lead to a sudden drop in blood pressure. There are several types of reflex syncope:
  • Neurally Mediated Syncope (Vasovagal Syncope) is triggered by strong emotions like fear, anxiety, or pain. This type is caused by activation of the autonomic nervous system that induces sudden vasodilation in the body, reducing blood flow to the brain.
  • Vasodepressor Syncope is caused by standing up quickly.
  • Situational Syncope applies to syncope triggered by specific activities such as urinating, coughing, or vomiting.
  • Carotid Sinus Syncope is caused by pressure on the carotid sinus nerve in the neck.

• Orthostatic Syncope (Orthostatic Hypotension): Fainting caused by an abrupt shift in blood pressure when standing up from a sitting position. This type is known as orthostatic syncope or postural hypotension.
• Micturition syncope: Also known as fainting during urination, micturition syncope occurs during or after urination. The precise cause is unknown. While usually not serious, it can be alarming and requires medical evaluation to rule out underlying conditions.^[7]
• Syncope with an Unknown Cause: Fainting not caused by any of the mentioned types.

Symptoms

The most common symptom of fainting is a temporary loss of consciousness.

Other symptoms may occur before or after syncope, including:

• Nausea or vomiting
• Confusion or disorientation
• Loss of bowel control
• Headache
• Chest pain
• Shortness of breath
• Irregular heartbeat
• Seizures

If you experience any of these symptoms, it is necessary to seek medical attention immediately.

Fainting and loss of bladder control. It is uncommon to lose bladder control when you faint. If a person loses control of their bladder while fainting, it may be a sign of a seizure or stroke.^[8] Loss of bladder control is also not the same as micturition syncope, which occurs during or after emptying the bladder normally.

Why do the eyes roll back when fainting ? When you faint, your body tries to conserve blood flow to the brain. The blood vessels in your eyes might constrict, making your eyes appear to roll back in your head.

Complications and Risks

Syncope can cause complications if not treated properly and could also be a sign of an underlying medical condition.

Potential complications of syncope include:

• Injury: If you fall when you faint, you could injure yourself. Older adults are most likely to fall and risk bone fractures.
• Head trauma: If you hit your head when you faint, you could sustain a head injury. Head injuries may increase the risk of acquiring brain damage.
• Sudden cardiac death (SCD): In rare cases, syncope can signify a severe heart condition, such as an arrhythmia. Athletes often succumb to hypertrophic cardiomyopathy (heart enlargement), which increases their odds of sudden cardiac death.

If you experience fainting episodes, it is essential to see your doctor to rule out any underlying medical conditions.

What to Do if You Feel Faint? 

If you feel like you are about to pass out, take the following steps^[9]:

1. Sit or lie down immediately to prevent falling and injuring yourself.
2. Put your head between your knees or lie down with your feet elevated to increase blood flow to the brain.
3. Slowly inhale as deeply as possible to regulate your breathing.
4. Loosen any clothing that hampers blood flow, if possible, or remove clothing that raises body temperature too much.
5. If you cannot sit or lie down, try to find something to hold onto for support.

How long should you wait to sleep after fainting?

It is generally safe to sleep after fainting, but you should make sure you are lying down in a safe position. Also, drink plenty of fluids to help rehydrate your body.

If you experience any dizziness or lightheadedness after waking up, it is best to rest for a few hours before resuming your normal activities.

When Should You Seek Medical Attention?

In most cases, syncope does not require medical attention.

You should seek medical attention if you or someone you know has any of the following symptoms:

• Frequent fainting spells
• History of heart problems
• Difficulties or pain during breathing before or after
• Head injury
• Loss of consciousness for more than a few minutes
• Seizures
• Difficulty regaining consciousness
• Sudden change in vision or speech

How Is Fainting Diagnosed ?

To diagnose syncope, your doctor will put you through a physical exam and take down your medical history.

If indicated, they will order tests to pinpoint the cause of your fainting episodes. These tests may include:

• Electrocardiogram (ECG or EKG): This test records the heart's electrical activity and can detect abnormalities.
• Exercise stress test: This test monitors your heart rate and blood pressure during exercise to check for exercise-induced syncope.
• Echocardiogram or transesophageal echocardiogram: These tests use ultrasound waves to visualize the heart and check for structural abnormalities.
• Tilt table test: This test measures your blood pressure and pulse while lying down, sitting, and standing to simulate daily activities and identify posture-related fainting episodes.
• Electrophysiology study (EP): This test records the heart's electrical activity and can identify abnormal electrical signals that may be causing syncope.
• Holter monitor or event monitor: These monitors record your heart rate and rhythm for a prolonged period to identify patterns associated with fainting.

How Is Fainting Treated?

Treatment for fainting depends on the underlying cause. In most cases, syncope requires no acute treatment and will resolve independently.

If caused by an underlying medical condition, your doctor may suggest lifestyle changes, compression stockings, prescription drugs, or surgery. These primarily improve overall cardiovascular and metabolic health.^[10]

Standard surgical treatment options aim to regulate the heartbeat:

• Cardioversion: A procedure that uses electrical shock to restore a normal heartbeat.
• Pacemakers: In some instances, a pacemaker can help regulate the heart's rhythm and prevent sudden drops in blood pressure.
• Catheter ablation: For certain types of arrhythmias, catheter ablation may destroy or modify abnormal electrical pathways in the heart.
• Implantable cardioverter-defibrillators (ICDs): An ICD may get implanted for severe arrhythmias. ICDs monitor the heart's rhythm and deliver electrical shocks to restore a normal heartbeat.

How Can You Prevent Fainting?

Somebody with syncope cannot always prevent it. Steps that may reduce your risk include:

• Keeping hydrated and drinking plenty of water throughout the day.
• Avoiding triggers, such as emotional stress, the sight of blood, or standing up too fast.
• Eating regular, balanced meals to maintain stable blood glucose.
• Sitting down or standing up slowly.
• Following your doctor's prescription and consulting with them about side effects.

Conclusion

Fainting, also known as syncope, is a common occurrence that can happen to anyone. It is usually not a cause for concern and does not require medical attention. Prevent syncope by avoiding triggers, remaining hydrated, and keeping blood glucose levels stable. If you experience frequent fainting spells, it is vital to seek medical attention.

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