Have you ever experienced transient dizziness or palpitations with sudden fainting or loss of consciousness? Most of the times it is assumed to be a temporary weakness caused by improper diet, lack of sleep or over exerted stress. However, while it might stand true sometimes, the common faint can be something more serious. Fainting can not only lead to fatal injuries caused due to falling but can be the primary symptom for an underlying medical condition.

Mr. Kapoor (name changed), a 50-year old professional was very active physically, working for over 15 hours every day. One afternoon he suddenly fainted and was rushed to the hospital. On conducting an ECG, the results were normal. However, the fainting episode recurred after a few days. He sought medical intervention from a cardiologist and was put on a long-term ECG Recording System for monitoring. The ECG Recorder detected rhythm disturbances in his heart, commonly called arrhythmia. The patient was having an episode of slow heart rate which he was able to tolerate. However, in some patients with very high heart rate, arrhythmia can lead to sudden death. What is fainting and who does it affect? Fainting is referred to as syncope in medical terms. The American Heart Association defines syncope as a temporary loss of consciousness caused due to insufficient flow of blood to the brain. This occurs when the heart stops pumping enough oxygen into the brain resulting in low blood pressure. The onset of syncope is sudden and the recovery is almost spontaneous. It is triggered by factors such as sweating, overheating, dehydration exhaustion or accumulation of blood in the legs due to a change in body position. While people of any age can experience syncope, it is more common in the elderly, who are also at a greater risk of fatality. People with a coronary artery disease, congenital heart defects, ventricular dysfunction, those who have suffered heart attacks, those having slowed conduction system and genetic mutations are most prone to risk. Quick facts -Up to 50% of people will experience a faint (blackout) during their life
-30% of old aged patients, who have experienced syncope will not be aware that they have fainted leaves the loss of consciousness untreated in many cases
-Many syncopal attacks are mistaken for epilepsy. However, epilepsy only affects slightly less than 1% of the population Early warning signs -Pale skin appearance
-Skipped beat or Palpitation
-Weakness
-Lightheadedness
-Nausea
-Sweating
-Rapid breathing Why is fainting fatal? Contrary to popular belief that fainting always occurs due to neurological causes, the real cause often is cardiac in nature. The primary cause for these unexplained fainting and dizziness episodes can also be related to heart conditions that you could be suffering from. For example, syncope is a primary symptom for one of the most common heart disorders called cardiac arrhythmias (abnormal heart rhythm). In some cases, fainting is the only warning sign of an abnormal heart rhythm that could lead to sudden cardiac arrest and death for people with prior heart diseases. Hence identifying syncope and its underlying cause is very crucial. Arrhythmias if not treated on time can be fatal. How is it diagnosed? Any sudden loss of consciousness should be evaluated by trained doctors only. Syncope is diagnosed based on the patient’s history of fainting. The common methodology is to conduct a physical examination and electrocardiography (ECG). The blood sugar level and blood count may also be monitored. Based on the results, a more comprehensive cardiac assessment maybe required to assess the severity of the problem. Syncope can be managed with lifestyle changes, medication and therapies depending on the gravity of the medical condition.
The evaluation begins with a careful review of your medical history and a physical exam. Your doctor will ask you detailed questions about your symptoms and syncope episodes, including whether you have any symptoms before you faint and when and where the episodes happen.
Electrocardiography (ECG), The blood sugar level and laboratory tests may also be conducted. Based on the results of these tests, a more comprehensive cardiac assessment maybe required to assess the severity of the problem. Treatment approach Treatment of syncope depends on its cause and the results of your evaluation and testing. Patients with syncope should consult with their physicians regarding potentially dangerous activities, such as driving, certain jobs, or recreational activities.
Immediate treatment for most forms of noncardiac syncope includes having the person lie horizontally to restore consciousness. Treatment to prevent recurrent noncardiac syncope includes:
-Life style modification
-Prescribing medication Treatment of cardiac syncope is based on addressing the underlying cardiac condition and includes: -Medications
-Implantable cardioverter defibrillator (ICD)
-Pacemaker
-Radiofrequency catheter ablation
-Valvular surgery
-Coronary artery bypass graft surgery
-Angioplasty and stenting Other tests aimed at syncope: -Lying and standing blood pressure recording
-Heart monitor
-Implantable loop recorder (ILR)
-Tilt table testing

Points to Remember

-Keep a record of your fainting

-Consult an expert if you experience chest pain and shortness of breath, especially if you have a history of heart disease.

-Sit or lie down in case you feel like fainting If possible, elevate the person’s feet above their head for improving blood circulation to the brain.

-Don’t ignore any instance of fainting as it can be fatal

ByDr. Aparna Jaswal, Principle Consultant - Cardiology, Fortis Escorts, Delhi.

Source: indiatimes.com