Frequent fainting spells may prove fatal

Fainting is a temporary loss of consciousness (TLOC) that results in a fall if a person is upright, and it is referred to as syncope in medical terms. The onset of syncope occurs suddenly, may or may not be associated with warning signs, the duration is usually brief, lasting few seconds to few minutes unlike seizures where the length is prolonged, and the recovery is spontaneous, complete. The warning signs before an attack of fainting may be in the form of sweating, feeling of weakness, blackness in front of the eyes, butterflies in the stomach, palpitations in the chest, and at times can happen without warning. Fainting occurs because of insufficient blood flow to the brain and is almost always due to a cardiac cause.

Fainting/syncope is quite common, and it is estimated that it occurs in 15-25% of the general population. Fainting is often recurrent, may lead to poor quality of life, may result in injuries, and in some patients may point to underlying severe heart disease. Fainting can occur both in patients with a healthy heart as well as those with heart disease. People who have an underlying heart disease, especially a weak heart (low ejection fraction) are at an increased risk of fainting/syncope.  Fainting may be the only warning sign of abnormal heart rhythm (arrhythmia).

Rapid heartbeats such as ventricular tachycardia or ventricular fibrillation or slow heartbeats that result in the temporary stopping of the heart for a few seconds causing a temporary cessation of blood flow to the brain can result in fainting/syncope. Another common cause of faint/syncope is the sudden and brief fall in blood pressure in upright position causing a decreased blood supply to the brain. Often, fainting is improperly diagnosed as a fit/epilepsy, and the afflicted person undergoes unnecessary tests such as CT scan, MRI, neurological evaluation and improper therapy. Specific causes of fainting have good long term outcomes while some others may result in fatalities if not diagnosed and treated correctly.

Fainting/syncope occurs across age groups, but the causes vary depending on the age of the person. While fainting may not have severe outcomes in certain conditions, it can be fatal especially those with underlying cardiac ailments. Hence, identifying syncope and its underlying cause is very crucial. People with an increased risk of death are those with a family history of sudden death, underlying heart disease with poor pump function such as coronary artery disease and heart muscle disease (cardiomyopathies), congenital heart defects, and those with a condition in the electrical conduction system of the heart. It is important to differentiate between dangerous faints from harmless causes, as fainting can be a harbinger of sudden cardiac death in some conditions.

Fainting/ syncope is caused by a variety of cardiac condition, and hence the treatment is varied. Accurate diagnosis of the cause is crucial, as the treatment is determined based on the underlying disease. Syncope is managed by lifestyle changes, medications, and electrical therapies depending on the underlying causative.

The diagnostic evaluation of a faint is based on the detailed history, thorough physical examination, electrocardiogram (ECG), long term rhythm monitoring to correlate the symptoms with the ECG abnormality and specific test to evaluate the electrical conduction system.

Syncope should not be ignored as no episode of loss of consciousness is normal. While the causes of fainting/ are commonly believed to be neurological, the real reason is usually cardiac in nature. Therefore, one must visit a “cardiac electrophysiologist,” i.e., a heart rhythm expert, for diagnosis, differentiating dangerous from not so dangerous faints and proper treatment.

Do’s and dont’s

●    Do keep a record of fainting episode as even one episode of fainting needs to be evaluated
●    Do consult a heart rhythm expert at the earliest if you have fainted
●    Do lie down in case you feel like faint as it improves the blood circulation to the brain 

(The writer is a consultant electrophysiologist )