Fainting, or Syncopal Attacks, May Indicate Serious Problem
Maintaining Your Health
on Mackinac
By Yvan Silva, M.D.

Fainting or syncope is a temporary loss of consciousness. Most often there is a feeling of dizziness accompanied by falling, or the urge to lie down before falling. There may be a feeling of unusual heat or cold, or shaking or chills. Recovery is spontaneous and occurs soon after the episode. The most common cause is a temporary decrease in blood flow to the brain. In otherwise healthy individuals, lying down or getting into a sitting position and bringing the head down between the knees will promote recovery from the episode. Injuries from falling can, of course, be serious and repeated episodes of fainting require medical attention to determine the underlying disorder. Indeed, fainting episodes may point to a serious health disorder.

A common cause of fainting is physical exhaustion or extreme heat and dehydration. Loss of body salt in extremely hot environments, along with loss of body water, is known to cause fainting. Dehydration resulting from extreme physical exercise or long work hours, lack of sleep, and severe stress can cause fainting. Blood loss, anemia, and drops in blood pressure owing to changes in position, lying to sitting up or standing, may produce episodes of fainting.

Syncope, when the cause is not appreciable, can pose a challenge to doctor and patient in regard to diagnosis and treatment. Symptoms can result from a benign condition and pose almost no threat to health.

On the other hand, syncope can be a hallmark of a serious underlying condition that can pose an imminent threat to life. A heart condition may cause syncope. Therefore, a cardiac cause should be considered in older patients, patients with conditions of hypertension, diabetes, patients on multiple medications, and those with known heart failure, rhythm abnormalities, and abnormalities observed on electrocardiograms.

Common symptoms observed prior to syncope are a feeling of warmth, nausea, lightheadedness, dizziness, and sweaty palms. Sudden temporary loss of vision with perception of white light or blackouts can also occur.

A detailed history of the event or events and symptoms and signs of occurrences just before and after is crucial. A detailed physical examination should follow. Further cardiac testing with an electrocardiogram can detect certain abnormalities. An ultrasound examination of the heart, an echocardiogram, detects abnormalities of the muscle and heart valves and in some cases, a 24-hour recording of heart rhythm with a Holter monitor may be indicated. Further testing is undertaken when the degree of the heart disease is discovered.

When no serious condition is discovered, the remedy is to avoid circumstances under which fainting episodes occur.

Comprehensive testing to identify the cause of fainting is crucial because if untreated, the cause may be life-threatening.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.