Syncope: What Really Happened When You Fainted

by Ellen Tan, OMS-III

Syncope is the medical term for fainting or “passing out”. Losing consciousness is very scary and may be caused by many different reasons. The most important part about making the right diagnosis with your doctor is to provide a good history of the incident. This may be difficult because you might not remember all the details due to fainting. If possible, make sure to talk with those around you who witnessed the episode to hear what they observed.

Before seeing the doctor, prepare your answers to these questions:

  • What were you doing immediately before the event?
  • What symptoms did you have immediately preceding the event?
  • Did you injure yourself?
  • How long were you unconscious?
  • How long did it take for you to feel back to normal?
  • Was the event witnessed?
  • Any past history of fainting?
  • What medications are you taking?

Syncope is defined as having the following features:

  1. Usually preceded by symptoms such as dizziness.
  2. An abrupt loss of consciousness for a brief amount of time
  3. Spontaneous recovery

 Syncope is commonly mistaken for seizures. Differentiating between the two may be tricky and has major implications for treatment. History is key!

 Syncope is due to a drop in blood pressure and decreased blood flow to the brain. People fall to the ground or slump over in a chair and subsequently regain full consciousness in a short period of time because of the return of blood flow. Syncope is very common; one out of every three people will experience it in their lifetime [2].

Convulsive syncope is characterized by small jerking after fainting with spontaneous and complete recovery. This is due to decreased blood flow to the brain resulting in a seizure-like reaction. It is estimated to occur in 12% of patients presenting with syncope [1].

Other causes of syncope include:

  • Vasovagal: most common type of syncope where the heart beats too slowly and/or blood vessels expand causing less blood flow to the brain. Examples include: prolonged standing, emotional stress, blood draw, severe pain, coughing, sneezing, and urination/defecation.
  • Orthostatic: characterized by abrupt drop in blood pressure. Examples include: volume depletion (diarrhea, dehydration, bleeding) and dysfunctional autonomic system (Parkinson’s disease, diabetes). Medications for high blood pressure, depression, and psychiatric disorders can also cause this.
  • Cardiogenic: most concerning type of syncope originating from the heart. Examples include: irregular heart rhythms (too slow, pauses, blocks) and mechanical obstruction (aortic stenosis, enlarged heart, blood clot).

Treatment is aimed at finding out the underlying cause and avoiding those triggers if possible. Prevention techniques can be used, such as laying down with feet elevated when you feel like you are about to faint and using counter-pressure maneuvers (e.g. gripping fingers into a fist, tensing arms, crossing legs, squeezing thighs together)[4]

Be sure to visit a neurologist to have a comprehensive work-up after a fainting spell. Your doctor may get an electrocardiogram (ECG), electroencephalogram (EEG), electrolyte levels, blood pressure measurements in different positions (orthostatics), tilt table test, or carotid ultrasound.


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